A spatial analysis of tuberculosis related mortality in South Africa

BACKGROUND : South Africa, with an estimated annual tuberculosis (TB) incidence of 360,000 cases in 2019, remains one of the countries with the largest burden of TB in the world. The identification of highly burdened TB areas could support public health policy planners to optimally target resources and TB control and prevention interventions. OBJECTIVE : To investigate the spatial epidemiology and distribution of TB mortality in South Africa in 2010 and its association with area-level poverty and HIV burden. METHODS : The study analysed a total of 776,176 TB deaths for the period 2005–2015. Local and global and spatial clustering of TB death rates were investigated by Global and Local Moran’s Indices methods (Moran’s I). The spatial regression analysis was employed to assess the effect of poverty and HIV on TB mortality rates. RESULTS : There was a significant decrease in TB mortality rate, from 179 per 100,000 population in 2005 to 60 per 100,000 population in 2015. The annual TB mortality rate was higher among males (161.5 per 100,000 male population; (95% confidence interval (CI) 132.9, 190.0) than among females (123.2 per 100,000 female population; (95% CI 95.6, 150.8)). The 35–44 age group experienced higher TB mortality rates, regardless of gender and time. Hot spot clusters of TB mortality were found in the South-Eastern parts of the country, whereas cold spot clusters were largely in the north-eastern parts. Tuberculosis death rates were positively associated with poverty, as measured by the South African Multidimension Poverty Index (SAMPI) as well TB death rates in the neighbouring districts. CONCLUSION : The findings of this study revealed a statistically significant decrease in TB deaths and a disproportionate distribution of TB deaths among certain areas and population groups in South Africa. The existence of the identified inequalities in the burden of TB deaths calls for targeted public health interventions, policies, and resources to be directed towards the most vulnerable populations in South Africa.The South African Medical Research Council-National Health Scholars Programme and The Auckland University of Technology, Faculty of Health and Environment Sciences, Doctoral fees scholarship funding, New Zealand.https://www.mdpi.com/journal/ijerpham2022Statistic

Open Access

Challenges facing providers of imported malaria-related healthcare services for Africans visiting friends and relatives (VFRs

Sexual behaviour and practices among adolescent blood donors in Zimbabwe

Background The incidence of HIV is increasing among Zimbabwean adolescent blood donors, a group that contributes around 70% of total blood collections. This increase may pose public health challenges such as lack of adequate and safe blood. Previous research observed positive associations between history of sexually transmitted infections and HIV infection. However, the designs were mainly retrospective and cross sectional. This made it almost impossible to explore the complexity of sexual behaviour since data on sexual behaviour are not stored in the database for blood donors. Aims and objectives We sought to explore sexual behaviour and practices among adolescent blood donors as well as the contextual factors shaping such behaviour.Study design We carried out a qualitative study on 10 adolescent blood donors aged between 18 and 20 years, inclusive, and four (4) key informants, purposely selected from the professional fields comprising community nurses, high school teachers and HIV counsellors. Interviews were audio-taped and lasted 30 – 40 minutes. Results Most adolescent blood donors reported they practise sexual abstinence. Nevertheless, they also reported on the acceptability of unprotected sex with sexual partners perceived to be HIV negative. Social status ascribed to blood donors, and mandatory HIV screening of donated blood, were protective against risky sexual behaviour. However, socio-economic and cultural factors may override this. Conclusion Behavioural change models such as the Abstinence, Be faithful and consistent Condom use (ABC model) may not reverse the observed upward trend in HIV among this group. Addressing contextual factors may ensure a safe and consistent pool of adolescent blood donors in Zimbabwe

Does public subsidy of the cost of malaria chemoprophylaxis reduce imported malaria? A comparative policy analysis.

BACKGROUND: Chemoprophylaxis is recommended for at-risk travellers visiting malaria endemic regions. The majority of travellers with imported malaria have not used this, and travellers visiting friends and relatives have the largest burden of malaria and the lowest compliance to chemoprophylaxis. In 1995, the UK's Department of Health (DH) implemented a policy to make travellers fully responsible for the cost when purchasing chemoprophylaxis. This policy was not implemented in three Primary Care Trusts (PCTs) in London due to concern about the potential increase of imported malaria in their residents, and they maintained the public subsidy. An impact evaluation of the policy change was undertaken to determine if the continued subsidy reduced the incidence of imported malaria in one of the boroughs where the subsidy was maintained when compared to a borough where no subsidy was provided. METHODS: Between 2007 and 2010 prescriptions for malaria chemoprophylaxis were collected from pharmacy records and PCTs, and all cases of imported malaria reported from the tertiary hospital in each of the two boroughs were compared. RESULTS: The dispensed chemoprophylaxis prescriptions were nearly 8.8 times higher in Lambeth (where subsidized drugs were provided), than in Hackney. A Poisson model revealed significantly fewer reports of imported malaria per capita were made in Lambeth compared to Hackney (p = 0.042). CONCLUSIONS: The difference in malaria reports between the boroughs only just reached statistical significance, despite the considerable difference in chemoprophylaxis prescribing between the boroughs. Some travellers may not consider using chemoprophylaxis, irrespective of the cost. Regular evaluations of the recent policy changes in areas where malaria is subsidized will be important

Family factors associated with immunization uptake in children aged between twelve and fifty-nine months: a household survey in Kakamega Central district, Western Kenya

In this study, we assessed immunization uptake and identified family factors associated with immunization in children aged between 12 and 59 months in Kakamega Central, Western Kenya. A cross sectional study was conducted in 13 sub-locations between June and July 2013. Data on 577 children were collected from their respective caregivers, by trained research assistants. The proportion of fully immunized children was 80.9% (95% confidence interval 76.9-85.3%). Immunization coverage was higher among caregivers who had completed secondary school (88%), those who had attended antenatal care clinics (81%) and children born in a health facility (85%). Some evidence was seen of increasing coverage with increasing socio-economic status. No evidence for a gender difference in coverage was seen. In the logistic regression model, the risk factors for incomplete immunization were: low educational level of the caregiver [adjusted odd ratio (AOR)=0.25; P<0.005], never attending any antenatal care (ANC) (AOR=0.14; P<0.05) and delivery outside of health facilities (AOR=0.40; P<0.005). Further inquiry is required into this area to fully comprehend the inextricable linkage between factors affecting immunization

A Spatial Analysis of Tuberculosis Related Mortality in South Africa

Background: South Africa, with an estimated annual tuberculosis (TB) incidence of 360,000 cases in 2019, remains one of the countries with the largest burden of TB in the world. The identification of highly burdened TB areas could support public health policy planners to optimally target resources and TB control and prevention interventions. Objective: To investigate the spatial epidemiology and distribution of TB mortality in South Africa in 2010 and its association with area-level poverty and HIV burden. Methods: The study analysed a total of 776,176 TB deaths for the period 2005–2015. Local and global and spatial clustering of TB death rates were investigated by Global and Local Moran’s Indices methods (Moran’s I). The spatial regression analysis was employed to assess the effect of poverty and HIV on TB mortality rates. Results: There was a significant decrease in TB mortality rate, from 179 per 100,000 population in 2005 to 60 per 100,000 population in 2015. The annual TB mortality rate was higher among males (161.5 per 100,000 male population; (95% confidence interval (CI) 132.9, 190.0) than among females (123.2 per 100,000 female population; (95% CI 95.6, 150.8)). The 35–44 age group experienced higher TB mortality rates, regardless of gender and time. Hot spot clusters of TB mortality were found in the South-Eastern parts of the country, whereas cold spot clusters were largely in the north-eastern parts. Tuberculosis death rates were positively associated with poverty, as measured by the South African Multidimension Poverty Index (SAMPI) as well TB death rates in the neighbouring districts. Conclusion: The findings of this study revealed a statistically significant decrease in TB deaths and a disproportionate distribution of TB deaths among certain areas and population groups in South Africa. The existence of the identified inequalities in the burden of TB deaths calls for targeted public health interventions, policies, and resources to be directed towards the most vulnerable populations in South Africa

Imported malaria among people who travel to visit friends and relatives: is current UK policy effective or does it need a strategic change?

BACKGROUND: The proportion of all imported malaria reported in travellers visiting friends and relatives (VFRs) in the UK has increased over the past decade and the proportion of Plasmodium falciparum malaria affecting this group has remained above 80% during that period. The epidemiological data suggest that the strategies employed in the UK to prevent imported malaria have been ineffective for VFRs. This paper attempts to identify possible reasons for the failure of the malaria prevention strategy among VFRs and suggest potential alternatives. METHODS: A review of the current UK malaria prevention guidelines was undertaken and their approach was compared to the few data that are available on malaria perceptions and practices among VFRs. RESULTS: The current UK malaria prevention guidelines focus on educating travellers and health professionals using messages based on the personal threat of malaria and promoting the benefits of avoiding disease through the use of chemoprophylaxis. While malaria morbidity disproportionately affects VFRs, the mortality rates from malaria in VFRs is eight times, and severe disease eight times lower than in tourist and business travellers. Recent research into VFR malaria perceptions and practices has highlighted the complex socio-ecological context within which VFRs make their decisions about malaria. These data suggest that alternative strategies that move beyond a knowledge-deficit approach are required to address the burden of malaria in VFRs. DISCUSSION: Potential alternative strategies include the use of standby emergency-treatment (SBET) for the management of fevers with an anti-malarial provided pre-travel, the provision of rapid diagnostic testing and treatment regimen based in general-practitioner surgeries, and urgent and walk-in care centres and local accident and emergency (A&E) departments to provide immediate diagnosis and accessible ambulatory treatment for malaria patients. This latter approach would potentially address some of the practical barriers to reducing the burden of malaria in VFRs by moving the process nearer to the community