Mass Media Exposure and Safer Sex Negotiation among Women in Sexual Unions in Sub-Saharan Africa: Analysis of Demographic and Health Survey Data.

(1) Background: Improving sexual autonomy among women in sexual unions comes with various benefits, including the reduction of sexually transmitted and blood-borne infections. We examined the relationship between mass media exposure and safer sex negotiation among women in sub-Saharan Africa (SSA). (2) Methods: The study involved a cross-sectional analysis of Demographic and Health Survey (DHS) data of 29 sub-Saharan African countries. A total of 224,647 women aged 15–49 were included in our analyses. We examined the association between mass media exposure and safer sex negotiation using binary logistic regression analysis. The results are presented using a crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p < 0.05. (3) Results: The overall prevalence of safer sex negotiation among women in sexual unions in SSA was 71.6% (71.4–71.8). Women exposed to mass media had higher odds of negotiating for safer sex compared with those who had no exposure (aOR = 1.94; 95% CI = 1.86–2.02), and this persisted after controlling for covariates (maternal age, wealth index, maternal educational level, partner’s age, partner’s educational level, sex of household head, religion, place of residence, and marital status) (aOR = 1.40; 95% CI = 1.35–1.46). The disaggregated results showed higher odds of safer sex negotiation among women exposed to mass media in all the individual countries, except Ghana, Comoros, Rwanda, and Namibia. (4) Conclusions: The findings could inform policies (e.g., transformative mass media educational seminars) and interventions (e.g., face-to-face counselling; small group sensitization sessions) in SSA on the crucial role of mass media in increasing safer sex practice among women in sexual unions. To accelerate progress towards the achievement of the Sustainable Development Goal five’s targets on empowering all women and safeguarding their reproductive rights, the study recommends that countries such as Ghana, Comoros, Rwanda, and Namibia need to intensify their efforts (e.g., regular sensitization campaigns) in increasing safer sex negotiation among women to counter power imbalances in sexual behaviour

Impact of COVID-19 on surgical emergency presentations in a tertiary hospital in the developing world

BACKGROUND: The COVID-19 pandemic and the institution of measures to contain the spread of the virus have disrupted patients' elective and emergency care, with scarce resources being channeled towards care of emergency presentations and containing the virus. The study aimed to assess the impact of COVID-19 on surgical accidents and emergency presentations in a major teaching hospital. METHOD: This was a comparative retrospective study. All presentations between February to July 2019 (non-COVID-19 period) were compared with the same period in 2020 (COVID-19 period). Patients' biodata, including surgical specialty that managed the patient, diagnosis, and treatment offered, were collated and analyzed with IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: I.B.M. Corp. RESULTS: We included 3463 patients in the study; 2419 (69.9%) were males, while 1044(30.1%) were females. The mean age of the patients in 2019 was 31.83 ±19.31 years, and that of 2020 was 34.93±19.99 years (P=0.001). During the lockdown period, emergency surgical presentations declined significantly by 17% (1894 versus 1569: P=0.001). There was a general decline in surgical emergency presentations across surgical specialties, with orthopedic and otorhinolaryngology (E.N.T.) having the greatest impact (313 versus 202 P=0.044). Presentation for trauma decreased by 18% (1394 versus 1144 P=0.711). Operative interventions declined by 47% (292 versus 155 P=0.001). There was a decline of 31% in the number of admissions for in-patient care (420 versus 290 P=0.019). CONCLUSION: The COVID-19 lockdown in Nigeria was associated with a reduction in the number of surgical emergency presentations and surgical interventions

Impact of Real Shocks on Business Cycles in selected Sub-Saharan African Countries

This study examines business cycle fluctuations in selected Sub-Saharan African (SSA) countries. The study measures the impact of selected real shocks, namely: terms of trade shocks, commodity price shocks, and government spending shocks, on macroeconomic fluctuations in SSA. The impact of the selected shocks was measured by the Bayesian Panel Vector Autoregression (BPVAR) technique. It was ascertained from the results that real (i.e. productivity) shocks drive business cycles (macroeconomic fluctuations) in SSA countries which support theoretical inclination. Furthermore, from the empirical analysis, terms of trade shocks possess the highest positive impact on business cycles. At the same time, government expenditure has the highest negative impact on business cycle among the three selected real shocks across the SSA region. Thus, the study recommends that government institutions in SSA should embark on sound fiscal policy plan along with monetary policy to stabilise the economy during recessions and expansions. The study highlights the need for diversification of the export base of SSA countries to mitigate terms of trade losses usually occasioned by unfavourable commodity price shocks

Worms:Pernicious parasites or allies against allergies?

Host-parasite interactio

Blocking of tumor necrosis factor activity promotes natural repair of osteochondral defects in rabbit knee

Background and purpose Osteochondral defects have a limited capacity for repair. We therefore investigated the effects of tumor necrosis factor (TNF) signal blockade by etanercept (human recombinant soluble TNF receptor) on the repair of osteochondral defects in rabbit knees

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980–2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background: Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods: For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings: By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4–82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5–42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4–41·3] in 1980 to 83·6% [82·3–84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4–44·1) in 1980 to 79·8% (78·4–81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6–60·9) to 14·5 million (13·4–15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation: After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories : the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics

Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

Background: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings: In 2019, health spending globally reached$8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this,$13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and$1·4 billion was repurposed from existing health projects. $3·1 billion (22·4$2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7$1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Funding: Bill & Melinda Gates Foundation

HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

BACKGROUND: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. OBJECTIVE: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. DESIGN: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. RESULTS: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. CONCLUSIONS: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS