COVID-19 pandemic: ten research questions Africa must answer for itself

The COVID-19 pandemic is spreading through Africa and governments are making frantic efforts to control spread, hospitalizations and deaths. While control measures are being taken, research into the biomedical and socio-cultural aspects of the pandemic, relevant to the African population, should not be ignored. It should not be assumed that research performed in Asian, American and European populations will always be applicable to Africa. Rather, research should be done in Africa to answer questions peculiar to the epidemic on the continent and help inform international guidelines. National guidelines for treatment and prevention, patient recoveries and discharge, and public health control measures should be based on research performed in the appropriate context for them to be effective and robust. Urgent research is needed in viral immunology and shedding, treatment and prevention trials, protection of healthcare personnel, and antimicrobial use among others. In this article, we propose ten research questions that when answered in a timely manner by scientists in Africa, will enhance Africa’s response to the pandemic

Editorial

Two decades into the current millennium, there are still questions about the status and situatedness of Africa in the global community. One central question about Africa is the historical footprint and arrangements of the colonial occupiers. From this standpoint, additional questions center on the lived experiences of Africans, especially in terms of the colonial impact on settlement arrangements and planning models. Several policy initiatives aim to empower and improve the African condition from the global to the continental levels. From the global context, the United Nations-inspired Millennium Development Goals (MDGs) (2000 to 2015) and the Sustainable Development Goals (SDGs) (2015 to 2030) are instructive. While the former goals focused on the Global South, which included the African subregion, the latter set of goals focused on both the Global North and Global South (Hanson, Puplampu and Shaw, 2018). The SDGs, especially SDG 9 (industry, innovation, and infrastructure), SDG 11 (sustainable cities and communities), SDG 16 (peace, justice, and strong institutions), and SDG (partnership for the goals) are essential in addressing the nexus of the environment, human settlements, and global partnership. At the continental level is the African Union Agenda 2063 and its inspiring undertones of creating an Africa that Africans want based on sustainability (Africa Union et al., 2016). The important point is that both the global and continental policy initiatives have significant implications for any discussions on coloniality, autonomy, identity, and spatial justice, the issues at the heart of this special issue of the Journal of Inclusive Cities and Built Environment. It is thus an opportune time through this special issue to unpack how well contemporary policy and research on the continent have come to grips with the interplay between (de)coloniality, autonomy, identity, and spatial justice. The special issue aims to contribute in durable ways to the possibilities of reimagining space and place in the built environment from a decolonial lens. The reflections in this issue arise from engagement with questions of spatial difference, autonomy, identity, and change in Africa, aspects of which have become more apparent through the current debates on decolonization. These experiences form the basis of reflection stimulated in this issue to reflect on what confronts and motivates built environment knowledge holders in deepening the critique of past colonial injustices. The question of what the built environment (i.e., planning, urban planning, architecture, housing, social geography, and spatial planning) can do to contribute to the decolonial debate. Colonialism connotes a power relationship between the colonizer and the colonized, often expressed in a superior-inferior binary in state-to-state relations (Young, 2018; Whyte, 2018; Hechter, 2020). The legacies of colonialism are visible in a post-colonial society (MaldonadoTorres, 2017; Bonilla, 2020; Enns and Bersaglio, 2020, Patrick et al., 2022) and the pattern of power relations in such society (Ricaurte, 2019). While many may trace Africa’s colonial realities back to the conquest and subjugation of Africa in the slave trade era (Wabah and N-ue, 2020; Masaka, 2021), one can argue invariably that the official colonialization of Africa was formalized in the Berlin conference of 1884/85, chaired by Otto van Bismark (Idejiora-Kalu, 2019; Babatunde, 2020). The implications of this event for any conceptualization of African identity in the historical contemporary contexts cannot be overemphasized. Identity, it needs to be stressed, is about a sense of self and how others recognize and response to that sense of self. Indeed, is there an African identity currently in an era of neoliberal globalization

Management of TB/HIV co-infection: the state of the evidence

Tuberculosis (TB) and HIV are strongly linked. There is a 19 times increased risk of developing active TB in people living with HIV than in HIV-negative people with Sub-Saharan Africa being the hardest hit region. According to the WHO, 1.3 million people died from TB, and an additional 300,000 TB-related deaths among people living with HIV. Although some progress has been made in reducing TB-related deaths among people living with HIV due to the evolution of diagnostics, treatment and antiretroviral HIV treatment, multi drug resistant TB is becoming a source of worry. Though significant progress has been made at the national level, understanding the state of the evidence and the challenges will better inform the national response of the opportunities for improved patient outcomes.Keywords: Tuberculosis, management, HIV, MDR TB, GhanaFunding: Non

Psychological comorbidities in epilepsy: a cross-sectional survey among Ghanaian epilepsy patients

Objective: To evaluate the prevalence and patterns of psychiatric disorders in epilepsy patients at the Korle-Bu Teaching hospital, Accra, Ghana.Design: The study design was a cross-sectional surveySetting: The study was conducted at the Neurology Clinic of the Department of Medicine and Therapeutics, Korle-nBu Teaching hospital, Accra, Ghana.Participants: A total of one hundred and sixty-six patients diagnosed with epilepsy aged at least 18 years and accessing services at the neurology clinic participated in the study.Main Outcome Measure: Prevalence and patterns of psychiatric disorders among patients diagnosed with epilepsy using the Brief Symptom Inventory.Results: The mean age for onset of epilepsy was 20.1 ± 16.9 years, and generalized epilepsy (73.2%) was the major type of epilepsy identified. The aetiology of the epilepsy condition was unknown in most patients (71.1%). The estimated mean Brief Symptom Inventory scores in all the nine diagnostic psychiatry characteristics (Depression, Anxiety, Somatization, Hostility, Phobic Anxiety, Obsessive Compulsive Disorder, Psychoticism, Interpersonal Sensitivity, and Paranoid Ideation) were higher in the epilepsy patients compared to the normative data scores for non-patients. Global Severity Index scores for females were significantly higher (p=0.002) than the scores for males on all the psychological outcomes except hostility.Conclusion: Psychological disorders were prevalent among epilepsy patients, with females more likely to experience psychological problems than males. The findings call for a holistic approach in managing epilepsy to highlight and manage some exceptional psychological comorbidities

Diet quality and nutritional status of HIV-exposed children aged between 6 and 18 months in the Greater Accra Region of Ghana

IntroductionHIV-exposed children, even when uninfected, have a greater risk of malnutrition than unexposed counterparts. WHO guidelines recommend children aged 6–23 months be fed a variety of foods to meet nutrient requirements. This study aimed to determine infant and young child feeding (IYCF) practices among HIV-exposed children under 2 years old enrolled in a dietary intervention and to explore correlates of the IYCF indicators and associations between IYCF and nutritional status.MethodologySix hundred and eighty mother–child pairs were recruited from 19 health facilities from the Greater Accra Region. The sociodemographic data, anthropometry, hemoglobin, and dietary intake were recorded.ResultsNinety-five percent of HIV-positive mothers breastfed their babies, and 53% initiated breastfeeding in a timely manner. Around one in five mothers (21%) introduced liquids other than breastmilk to their children within the first 2 days of birth, and only around one in four children (26%) aged 12–23 months had received breast milk on the day before assessment. Ninety-three percent of babies between 6 and 8 months had been introduced to solid, semi-solid, or soft foods. Eighteen percent of children reached the threshold for Minimum Dietary Diversity (MDD) by eating from over five of eight food groups. Fifty-four percent received Minimum Meal Frequency (MMF), eating between 2 and 4 meals in a day. Eleven percent received the Minimum Acceptable Diet (MAD). Thirty-two percent were anemic. Underweight and stunting were 12 and 11%, respectively. Children of mothers aged 31–40 years were more likely to meet the MDD and MAD [OR = 2.8, 95%CI (1.185, 6.519), p < 0.05 and OR = 2.8, 95%CI (1.256, 6.279), p < 0.05] compared to children of mothers aged 30 years or less or aged above 40 years. Children from households earning more than GHS 500 were more likely to meet MMF than those from households earning less. No associations were found between IYCF and nutritional status.ConclusionFindings highlight the need for nutrition programs to educate HIV-exposed children’s caregivers on optimal feeding practices. The importance of continued breastfeeding and dietary diversity needs to be highlighted. Affordable, iron-rich foods should be promoted. Special attention should be paid to younger, less educated, and lower socioeconomic status mothers

Healthcare provider perspectives on HIV cure research in Ghana

INTRODUCTION: Antiretroviral therapy (ART) has reduced mortality and improved life expectancy among HIV patients but does not provide a cure. Patients must remain on lifelong medications and deal with drug resistance and side effects. This underscores the need for HIV cure research. However, participation in HIV cure research has risks without guaranteed benefits. We determined what HIV healthcare providers know about HIV cure research trials, the risks involved, and what kind of cure interventions they are likely to recommend for their patients. METHODS: We conducted in-depth qualitative interviews with 39 HIV care providers consisting of 12 physicians, 8 counsellors, 14 nurses, 2 pharmacists, 2 laboratory scientists, and 1 community advocate from three hospitals. Interviews were transcribed verbatim and coded, and thematic analysis was performed independently by two investigators. RESULTS: Participants were happy about the success of current treatments and hopeful that an HIV cure will be found in the near future, just as ART was discovered through research. They described cure as total eradication of the virus from the body and inability to test positive for HIV or transmit the virus. In terms of risk tolerance, respondents would recommend to their patients\u27 studies with mild to moderate risks like what patients on antiretroviral therapy experience. Participants were reluctant to recommend treatment interruption to patients as part of a cure study and wished trials could be performed without stopping treatment. Healthcare providers categorically rejected death or permanent disability as an acceptable risk. The possibility of finding a cure that will benefit the individual or future generations was strong motivations for providers to recommend cure trials to their patients, as was transparency and adequate information on proposed trials. Overall, the participants were not actively seeking knowledge on cure research and lacked information on the various cure modalities under investigation. CONCLUSION: While hopeful for an HIV cure, healthcare providers in Ghana expect a cure to be definitive and pose minimal risk to their patients

Peripheral neuropathy in patients with human immunodeficiency viral infection at a tertiary hospital in Ghana

Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38-10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26-0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36-1.83 and aOR = 2.17; 95% CI 0.93-5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS' quality of life

Clinical features of COVID-19 in Ghana: symptomatology, illness severity and comorbid non-communicable diseases

Objective: This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana.Methods: Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16.Results: Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD’s count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)].Conclusion: The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients

Prevalence of pneumonia by chest x-ray, associated demographic characteristics and health risk factors among COVID-19 patients in Ghana

Objective: The study was conducted to determine the prevalence of radiologically diagnosed pneumonia among COVID-19 patients and associated factors.Design, setting, and participants: A retrospective manual data extraction of 275 medical records of COVID-19 patients was conducted at two COVID-19 national treatment centres in Accra from March to May 2020. All patients had a chest x-ray done.Main outcome and analysis: The main outcome was the presence of pneumonia. Descriptive statistics and Chi-square test of independence were employed to determine the associations between independent variables and the presence of pneumonia. All analysis was performed using Stata 16, and a p-value ≤ 0.05 was deemed significantResults: The prevalence of pneumonia was 44%(95%CI) =38.2-50.0). Chi-square independent test indicated that pneumonia in the COVID-19 patients was associated with educational level, history of domestic and international travel, mass gathering in the past 14 days before diagnosis, and discharge plan (p-value< 0.05). Patients classified as secondary cases (61.5%) and those discharged as fully recovered from the health facility (61.2%) had a higher prevalence of pneumonia. In addition, COVID-19 patients with hypertension (32.1%) and asthma (5.2%) had a significantly higher prevalence of pneumonia.Conclusion: Overall, the prevalence of pneumonia was 44% and was associated with the demographic and personal characteristics of the patients. Early detection through contact tracing and community surveillance should be intensified to pick up more asymptomatic cases. The role of the chest x-ray for triaging patients and for clinical management of symptomatic patients remains key

Unwillingness of patients in Ghana to interrupt antiretroviral therapy for HIV cure research

OBJECTIVES: Though antiretroviral therapy (ART) has reduced HIV infection into a manageable chronic disease, it does not provide for a cure. HIV cure trials may carry risks for patients who are generally doing well on ART, making it imperative that their input is sought as various types of cure methods and trials are designed. Few studies have sought the views of African patients on HIV cure studies. The objective of this study was to determine the views and preferences of people living with HIV (PLWH) in Ghana on cure research. METHODS: We used a questionnaire to interview 251 PLWH in Ghana about their willingness to engage in HIV cure research. We investigated their motivations, the types of cure they would prefer and which risks were acceptable to them. RESULTS: Most participants were enthusiastic about participating in cure research and driven by both altruistic and personal motives. Patients preferred a cure where they would continue follow-up with their doctor (88%) compared to being assured that they have been completely cured and did not need further follow-up (11%). The vast majority of the respondents were risk averse. Most patients (67%) would decline to interrupt ART as part of a protocol for HIV cure research. In bivariate analysis, participants above the age of 40 years were more likely to agree to treatment interruption during cure studies (OR 2.77; 95% CI 1.21-.6.34. CONCLUSIONS: Our results show that preferred cure modalities and risk tolerance for patients in Africa may be different from those of other parts of the world. Extensive social science and behavioural studies are needed on the continent to help inform future cure trials