BMJ Global Health最新文献

{"title":"A meta-core outcome set for stillbirth prevention and bereavement care following stillbirth in LMIC.","authors":"Kushupika Dube, Farai Marenga, Elizabeth Ombeva Ayebare, Carol Bedwell, Nasim Chaudhry, Idesi Chilinda, Angela Chimwaza, Declan Devane, Sudhindrashayana Fattepur, Unice Goshomi, Tayyeba Kiran, Rose Laisser, Tina Lavender, Tracey A Mills, Allen Nabisere, Zaib Un Nisa, Bellington Vwalika, Sabina Wakasiaka, Jamie J Kirkham","doi":"10.1136/bmjgh-2024-017688","DOIUrl":"10.1136/bmjgh-2024-017688","url":null,"abstract":"<p><strong>Study objective: </strong>Stillbirth is burdensome in low-income and middle-income countries (LMICs), especially in sub-Saharan Africa and South Asia. Currently, there are two core outcome sets (COS) for stillbirth (prevention and bereavement care), but these were developed with limited reflection of the needs of parents in an LMIC setting. To address this gap, the objective of this study was to establish consensus on the most important outcomes for stillbirth prevention and bereavement care following stillbirth in sub-Saharan Africa and South Asia.</p><p><strong>Methods: </strong>Previous stillbirth outcomes were reviewed for inclusion into the COS by senior research leaders and community engagement and involvement members from six sub-Saharan African and two South Asian countries. An online real-time Delphi survey was then conducted with healthcare professionals, parents who have experienced a stillbirth and researchers in the field to score the agreed list. The results of the Delphi were summarised and then discussed at a virtual consensus meeting where the final COS were agreed.</p><p><strong>Results: </strong>287 participants contributed towards the Delphi (143 midwives, 32 obstetricians, 50 mothers, 12 fathers and 50 researchers), with at least 2 parents attending the full consensus meetings. Consensus was reached on 13 core outcomes for stillbirth prevention covering 5 domains: obstetric, fetal, perinatal and neonatal outcomes and maternal complications. For bereavement care following a stillbirth, five core outcomes reached a consensus, which included outcomes related to labour and birth, a postpartum complication, care experience, mental health and emotional and social well-being.</p><p><strong>Discussion: </strong>These COS will improve the consistency of outcomes for future research in an LMIC setting. Additionally, they will complement existing COS for stillbirth prevention and bereavement care developed in high-income settings. The output from this work will move us towards a global set of outcomes that can be used in stillbirth research worldwide.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age- and sex-specific incidence rates and future projections for hip fractures in Zimbabwe.","authors":"Hannah Wilson, Tadios Manyanga, Anya Burton, Prudance Mushayavanhu, Joseph Chipanga, Samuel Hawley, Kate A Ward, Simon Graham, James Masters, Tsitsi Bandason, Matthew L Costa, Munyaradzi Ndekwere, Rashida A Ferrand, Celia L Gregson","doi":"10.1136/bmjgh-2024-017365","DOIUrl":"10.1136/bmjgh-2024-017365","url":null,"abstract":"<p><strong>Introduction: </strong>Population ageing in Africa is increasing healthcare demands. Hip fractures require multidisciplinary care and are considered an indicator condition for age-related health services. We aimed to estimate current hip fracture incidence in Zimbabwe, compare rates against other regional estimates and estimate future fracture numbers.</p><p><strong>Methods: </strong>All hip fracture cases in adults aged ≥40 years, presenting to any hospital in Harare over 2 years, were identified. From this, age- and sex-specific hip fracture incidence rates per 100 000 person-years were estimated using 2022 Zimbabwean Census data and compared with South African and Botswanan estimates. Furthermore, using the United Nations population projections, future hip fracture numbers were estimated to 2052 for Zimbabwe.</p><p><strong>Results: </strong>In 2022, 1 83 312 women and 1 79 212 men aged ≥40 years were living in Harare (14.9% of the city's population). Over 2 years 243 hip fracture cases, 133 (54.7%) female, mean (SD) age 71.2 (15.9) years, were identified. Most presented to public hospitals (202 [83.1%]) and were fragility hip fractures (211 [86.8%]); high-impact trauma (eg, traffic accidents) was more common in younger men. Presentation delays of >2 weeks were common (37.4%). Incidence rates for adults aged ≥40 years in Harare (observed) and Zimbabwe (estimated) were 33.5 and 53.8/100 000 person-years, respectively. Over age 50, rates increased with age, with the highest rates seen in women aged ≥85 years (704/100 000 person-years). Age-standardised hip fracture incidence rates are broadly comparable between Zimbabwe, Botswana and Black South Africans in those aged 40-69 years; thereafter, rates in Zimbabwean women and men exceed those in Botswana and South Africa. Across Zimbabwe, the number of hip fractures occurring annually is expected to increase more than 2.5-fold from 1709 in 2022 to 4414 by 2052.</p><p><strong>Conclusion: </strong>In Zimbabwe, most hip fractures in adults ≥50 years are fragility fractures, consistent with age-associated osteoporosis; incidence rates exceed those previously reported regionally. Demands on already challenged healthcare systems will increase.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening advanced therapy for sickle cell disease in Africa: experience from sickle cell disease centre in Dar es Salaam, Tanzania.","authors":"Daima Bukini, Aisha Rifai, Collin Kanza, Fredrick Luoga, Deogratius Maingu, Kassim Kassim, Jennifer Mashaka, Eka Patricia Kisali, Salmaan Karim, Mohamed Zahir Alimohamed, Janeth Manongi, Winfrida Lema, Harrison Chuwa, Sisawo Konteh, Florence Urio, Irene Kida Minja, Emmanuel Balandya, Grace Moshi, Julie Makani","doi":"10.1136/bmjgh-2024-017878","DOIUrl":"10.1136/bmjgh-2024-017878","url":null,"abstract":"<p><p>Despite progress in healthcare services for individuals living with sickle cell disease (SCD) in Africa, substantial gaps remain in advanced treatments for SCD. To help address this burden, Tanzania has established one of the largest single-centre SCD programmes in the world and developed an advanced therapy programme for SCD focused on patient engagement and advocacy, clinical activities involving exchange blood transfusion (ExBT) and haematopoietic stem cell transplant (HSCT), gene therapy (GT) preparedness, and enabling partnerships. This report describes the programme's genesis, structure and progress achieved. Patient engagement camps and patient-focused workshops conducted since early 2021 have involved more than 150 patients, family caregivers and healthcare providers. A patient registry was established by screening 1500 patients eligible for advanced therapies with 157 identified to benefit from advanced treatments for SCD. Out of which 22 patients received ExBT, and human leucocyte antigen typing was conducted on 127 individuals to establish a registry of family members with potential to be HSCT donors. Target product profiles were devised for minimum and optimum criteria of GT products to guide drug discovery and development efforts, and qualitative research was conducted to investigate factors anticipated to influence successful adoption of GTs for SCD in Africa. The programme's multifaceted components have been enabled by institutional networks and collaborations established at national, regional and global levels. The programme presented opportunities to deliver cost-effective advanced treatment and curative options for SCD in Tanzania and lessons learnt may be applicable to inform similar efforts in other African regions where SCD is highly endemic.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How climate change is shaping young people's health: a participatory, youth co-led study from Bangladesh, Guatemala and Nigeria.","authors":"Jessie Pinchoff, Eno-Obong Etetim, Damilola Babatunde, Eleanor Blomstrom, Sigma Ainul, Toyin Olamide Akomolafe, Brian Medina Carranza, Angel Del Valle, Karen Austrian","doi":"10.1136/bmjgh-2024-016788","DOIUrl":"10.1136/bmjgh-2024-016788","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change is shaping adolescent and young people's (AYP) transitions to adulthood with significant and often compounding effects on their physical and mental health. The climate crisis is an intergenerational inequity, with the current generation of young people exposed to more climate events over their lifetime than any previous one. Despite this injustice, research and policy to date lacks AYP's perspectives and active engagement.</p><p><strong>Methods: </strong>Participatory, youth co-led qualitative focus group discussions were held in Bangladesh, Guatemala and Nigeria in mid-2023. A total of 196 AYP ages 12-25 years participated. Open-ended questions elicited responses regarding AYP knowledge, experiences and perceptions of climate change. Using NVivo software, translated transcripts were coded to explore and synthesise key thematic areas.</p><p><strong>Results: </strong>Respondents discussed varied climate exposures and associated health risks, for example, how flooding events were impeding access to sexual and reproductive health commodities. Acute climate events like flooding and cyclones increased perceived risk of early marriage and gender-based violence in Bangladesh and Guatemala. In Nigeria, respondents discussed health effects of extreme heat, and how droughts were shifting women into more traditionally male roles in agriculture and income-generating activities, increasing the perceived risk of household tensions and gender-based violence. Commonly reported themes included perceived climate impacts on sexual and reproductive health including early marriage or gender-based violence. Another common theme was anxiety about climate change, its effects on economic and food insecurity in communities and feeling hopeless, lacking agency and not feeling supported by local institutions, all linked with worse mental health.</p><p><strong>Conclusion: </strong>Our results summarise how AYP perceive climate change is affecting their physical and mental health, finding similarities and differences across these three settings. Our results can inform the development of policies and programmes that directly address AYP needs in a way that is inclusive and responsive.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatment attrition after rifampicin-resistant tuberculosis diagnosis with Xpert MTB/RIF or ultra in high TB burden countries: a systematic review and meta-analysis.","authors":"Christelle Geneviève Jouego, Tom Decroo, Palmer Masumbe Netongo, Tinne Gils","doi":"10.1136/bmjgh-2024-015977","DOIUrl":"10.1136/bmjgh-2024-015977","url":null,"abstract":"<p><strong>Introduction: </strong>The WHO endorsed the Xpert MTB/RIF (Xpert) technique since 2011 as initial test to diagnose rifampicin-resistant tuberculosis (RR-TB). No systematic review has quantified the proportion of pretreatment attrition in RR-TB patients diagnosed with Xpert in high TB burden countries.Pretreatment attrition for RR-TB represents the gap between patients diagnosed and those who effectively started anti-TB treatment regardless of the reasons (which include pretreatment mortality (death of a diagnosed RR-TB patient before starting adequate treatment) and/or pretreatment loss to follow-up (PTLFU) (drop-out of a diagnosed RR-TB patient before initiation of anti-TB treatment).</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we queried EMBASE, PubMed and Web of science to retrieve studies published between 2011 and 22 July 2024, that described pretreatment attrition for RR-TB using Xpert in high TB burden countries. Data on RR-TB patients who did not start treatment after diagnosis and reasons for not starting were extracted in an Excel table. A modified version of the Newcastle-Ottawa scale was used to evaluate the risk of bias among all included studies. The pooled proportion of pretreatment attrition and reasons were assessed using random-effects meta-analysis. Forest plots were generated using R software.</p><p><strong>Results: </strong>Thirty eligible studies from 21 countries were identified after full-text screening and included in the meta-analysis. Most studies used routine programme data. The pooled proportion of pretreatment attrition in included studies was 18% (95% CI: 12 to 25). PTLFU and pretreatment mortality were, respectively, reported in 10 and nine studies and explained 78% (95% CI: 51% to 92%) and 30% (95% CI: 15% to 52%) of attrition.</p><p><strong>Conclusion: </strong>Pretreatment attrition was widespread, with significant heterogeneity between included studies. National TB programmes should ensure accurate data collection and reporting of pretreatment attrition to enable reliable overall control strategies.</p><p><strong>Prospero registration number: </strong>CRD42022321509.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building resilience against cholera: lessons from the implementation of integrated community strategy for cholera control in Zambia.","authors":"Moses Mwale, Peter Jay Chipimo, Precious Kalubula, Ladislas Hibusu, Stella Mumba Chomba Mulima, Kafusha Kapema, Kelvin Mwangilwa, Nyuma Mbewe, Fred Kapaya","doi":"10.1136/bmjgh-2024-017055","DOIUrl":"10.1136/bmjgh-2024-017055","url":null,"abstract":"<p><p>Cholera has remained a persistent public health challenge in Zambia since the country's first reported outbreak in 1977. The recent outbreak, which began in October 2023 and is ongoing as of June 2024, is the most severe in Zambia's history and part of the larger 2022-2024 Southern Africa cholera outbreak, which has affected multiple countries in the region. This article describes the implementation of the integrated community strategy for cholera control (ICSCC) in three districts of the Copperbelt Province during this outbreak. The ICSCC is a comprehensive, community-centric public health approach that integrates surveillance, case management, water, sanitation and hygiene interventions, community engagement and infection prevention measures. The strategy's implementation involved deploying multidisciplinary technical teams, training community-based volunteers and healthcare workers in the affected communities. This approach led to a rapid reduction in cholera cases and mortality, largely due to enhanced surveillance, community education sessions and improved sanitation practices. The ICSCC also improved stakeholder coordination and enabled rapid communication for early response to cholera hotspots. Key lessons learnt include the importance of robust coordination, early community involvement and context-specific adaptations. The strategy's emphasis on data-driven decision-making and adaptation to local socio-cultural dynamics was crucial for its effectiveness. These findings underscore the potential of integrated community-based approaches in managing cholera outbreaks, enhancing public health preparedness and building long-term resilience. The ICSCC strategy offers a scalable model for regions facing similar public health challenges, providing valuable insights for policymakers and practitioners on the effectiveness of community involvement in managing public health crises.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis.","authors":"Simon Mwima, Laura M Bogart, William Musoke, Semei C Mukama, Stella Allupo, Herbert Kadama, Rose Naigino, Barbara Mukasa, Rhoda Kitti Wanyenze","doi":"10.1136/bmjgh-2024-017368","DOIUrl":"10.1136/bmjgh-2024-017368","url":null,"abstract":"<p><strong>Introduction: </strong>In Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influencing PrEP continuation and discontinuation among fisherfolk in Uganda using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Methods: </strong>Participants were recruited from two fishing communities near Entebbe, Uganda. One community received enhanced PrEP support (adherence support, educational workshops and check-in calls), while the other received standard healthcare outreach. Forty fisherfolk (20 who continued PrEP and 20 who discontinued PrEP) were interviewed 6 months after initiating PrEP. Data were analysed using directed content analysis, with high inter-rater consistency. Ethical approval and informed consent were obtained.</p><p><strong>Results: </strong>Findings highlighted several determinants of PrEP continuation and discontinuation across the CFIR domains. Intervention characteristics such as side effects and the pill burden were significant barriers, particularly for women who reported nausea and stomach issues. Individual characteristics revealed that perceived HIV risk influenced PrEP use, with women's decisions often influenced by their partners' behaviours and mobility. However, insufficient information and education, especially among women, led to misunderstandings and discontinuation. Inner-setting factors like mobility issues and the distance to healthcare clinics posed significant barriers exacerbated by the geographical isolation of fishing communities. In the outer setting, high HIV prevalence motivated PrEP initiation, but stigma, particularly the misconception that PrEP is an antiretroviral drug used by people living with HIV, led to discontinuation.</p><p><strong>Conclusion: </strong>Fisherfolk in Uganda encounter multiple barriers to PrEP continuation, with women facing more significant challenges. Enhanced support strategies are essential for improving PrEP adherence and informing future HIV prevention interventions in high-risk populations.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of the progress made in the implementation of the regional framework for cholera prevention and control in the WHO African region.","authors":"Fred Kapaya, Mory Keita, Vincent Dossou Sodjinou, Miriam Nanyunja, Allan Mpairwe, Ebenezer Obi Daniel, Godwin Akpan, Tamayi Mlanda, Shikanga O-Tipo, Amarachi Tikal Abianuru, Ibrahim Mamadu, John Masina, Alice Igale Ladu, Fred Athanasius Dratibi, Otim Patrick Cossy Ramadan, Fiona Braka, Etien Luc Koua, Philippe Barboza, Dick Chamla, Abdou Salam Gueye","doi":"10.1136/bmjgh-2024-016168","DOIUrl":"10.1136/bmjgh-2024-016168","url":null,"abstract":"<p><p>High-burden cholera outbreaks, spreading beyond the traditional cholera-endemic countries, have been reported since 2021 in the WHO African region. Member states in the region have committed to the global goal of cholera elimination by 2030. To track progress towards this goal, WHO-African countries adopted a regional cholera prevention and control framework in 2018. This study reports on 27 countries' 5-year achievements in implementing the cholera regional framework for cholera prevention, and control. Data collected through a web-based self-assessment tool were analysed and visualised through Power BI. Data were provided by national teams of experts on cholera based on the milestones of the framework. Countries' specific progress and regional progress were calculated. The overall regional progress was 53%, ranging from 19% in Mauritania to 76% in Ethiopia. Out of the 27 countries, 3 had made good progress while 14 had fair and 10 had insufficient progress. At the regional level, 4 milestones were on track, 7 were fair and 10 had insufficient progress. Cholera hot spot mapping had the highest score at 85%, while development of investment cases for cholera control scored the lowest at 14%. Although appreciable progress was noted in some milestones, the progress against critical milestones, including for water, sanitation and hygiene, that form the bedrock of cholera control, was insufficient. Effective implementation of the cholera prevention and control framework anchored on strong government commitment and ownership is essential to curb the current trend of cholera outbreaks and improve the likelihood of cholera elimination by 2030 in Africa.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender equality and quality of life must be central to the design and delivery of sanitation.","authors":"Akanksha A Marphatia, Sheillah Simiyu, Meriel Flint O'Kane, Kelly T Alexander, Ana Carolina Argolo Nascimento de Castro, Ginette Azcona, Patience Esi Boni-Morkla, Salome A Bukachi, Phylis Busienei, Bethany A Caruso, Claire Chase, Jenala Chipungu, Anju Dwivedi, Richard Johnston, Indira Khurana, Antoinette Kome, Wanjiku Kuria, James Labadia, Fungai Makoni, Blessing Mberu, Sujoy Mojumdar, Janet Mule, Lydia Namatende Sakwa, Naomi Njeri, Fernanda Abreu Oliveira de Souza, Lauren Pandolfelli, Petunia Ramunenyiwa, Isha Ray, Malini Reddy, Pritum Kumar Saha, Utkarsh Sinha, Sheela S Sinharoy, Tom Slaymaker, Emmanuel Uguru, Kara Uhl, Sera L Young, Ian Ross, Oliver Cumming","doi":"10.1136/bmjgh-2024-018238","DOIUrl":"10.1136/bmjgh-2024-018238","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the burden of cholera in the WHO African region: patterns and trends from 2000 to 2023 cholera outbreak data.","authors":"Etien Luc Koua, Fleury Hybriel Moussana, Vincent Dossou Sodjinou, Freddy Kambale, Jean Paul Kimenyi, Saliou Diallo, Joseph Okeibunor, Abdou Salam Gueye","doi":"10.1136/bmjgh-2024-016491","DOIUrl":"10.1136/bmjgh-2024-016491","url":null,"abstract":"<p><strong>Introduction: </strong>Cholera outbreaks remain persistent in the WHO African region, with an increased trend in recent years. This study analyses actual drivers of cholera including correlations with water, sanitation, and hygiene (WASH) indicators, and climate change trends.</p><p><strong>Methods: </strong>This was a cross-sectional descriptive and analytic study. Cholera data from 2000 to 2023 and data relating to cholera drivers were compiled and analysed through multi-level exploratory analysis. We cross-referenced several WASH indicators, and generated a similarity matrix to categorise countries or subnational units into groups using principal component analysis and K-means clustering. We integrated cholera outbreak data with WASH indicators and created a matrix of indicators relevant for analysing cholera burden. We conducted summary statistics, temporal visualisations, Geographic Information System (GIS) mapping, trend analysis and statistical tests for correlations to derive patterns and trends from the data, derive similarities and develop projections.</p><p><strong>Results: </strong>A total of 2 727 172 cases and 63 182 deaths were reported from 44 countries, representing 94% of the 47 countries in the region, from 2000 to 2023. The case fatality ratio of 2.3% is suggestive of issues in case management. A total of 684 outbreaks were reported, with the highest burdens in Nigeria and the Democratic Republic of the Congo. Median detection time to outbreak was 2 days, while median time for outbreak control was 92 days. Cholera incidence seemed higher in the period 2014 to 2023 than in the period before 2014. The study results confirmed correlations between WASH indicators and cholera outbreaks. Risks factors include drinking surface water, lacking soap and/or water, and open defaecation. Over 29% and 58.8% of the population lack access to basic water and basic sanitation, respectively.</p><p><strong>Conclusion: </strong>Insufficient access to WASH services remains the main predisposing factor for cholera in the WHO African region. Political leaders should invest more in access to WASH, strengthen multisectoral collaboration, and improve availability of needed tools to increase the likelihood of meeting cholera elimination goals by 2030.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}