Epidemiology and Health

Cohort Profile

The Asenze Cohort Study in KwaZulu-Natal, South Africa: protocol and cohort profile: Chris Desmond, Gabriella A. Norwitz, Jane D. Kvalsvig, Rachel S. Gruver, Shuaib Kauchali, Kathryn G. Watt, Nonhlanhla P. Myeza, Adele Munsami, Leslie L. Davidson; Epidemiol Health. 2022;44:e2022037. Published online April 5, 2022; DOI: https://doi.org/10.4178/epih.e2022037

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Abstract

The Asenze cohort is set in South Africa, a middle-income country impacted by one of the highest global rates of people living with HIV/AIDS and high levels of socioeconomic inequality. This longitudinal population-based cohort of children and their primary caregivers assesses household and caregiver functioning, child health, social well-being, and neuro-development from childhood through adolescence. Almost 1,600 children born at the peak of the human immunodeficiency virus epidemic (2003-2005) were followed (with their primary caregivers) in 3 waves, between 2008 and 2021, at average ages of 5, 7, and 16. Wave 3 is currently underway, having assessed over 1,100 of the original wave 1 children. Wave 4 begins in 2022. The study, with a dyadic structure, uses a broad range of measures, validated in South Africa or recommended for global use, that address physical, social and neuro-development in childhood and adolescence, and the social, health, and psychological status of children’s primary caregivers. The Asenze study deepens our understanding of childhood physical, cognitive, and social abilities and/or disabilities, including risk-taking behaviors, and biological, environmental, and social determinants of health. We anticipate the findings will contribute to the development of community-informed interventions to promote well-being in this South African population and elsewhere.

Summary

Key Message
The Asenze Cohort Study, one of a limited number of population-based studies set in low- and middle-income countries, with a high level of retention, provides an understanding of neuro-developmental, psychosocial, home environmental and economic exposures and outcomes of over 1100 adolescents and their primary caregivers in KwaZulu-Natal, South Africa.

Citations

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The impact of caregiver mental health on child prosocial behavior: A longitudinal analysis of children and caregivers in KwaZulu-Natal, South Africa
Gabriella A. Norwitz, Chris Desmond, Rachel S. Gruver, Jane D. Kvalsvig, Amaleah F. Mirti, Shuaib Kauchali, Leslie L. Davidson, Giulia Ballarotto
PLOS ONE.2023; 18(10): e0290788. CrossRef

Perspectives

Conceptual frameworks regarding waterborne diseases in sub-Saharan Africa and the need of for a new approach to urban exposomes: Alexandre Zerbo, Rafael Castro Delgado, Pedro Arcos González; Epidemiol Health. 2021;43:e2021079. Published online October 6, 2021; DOI: https://doi.org/10.4178/epih.e2021079

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Abstract

Sub-Saharan African countries, like many other low-income countries, have experienced urban socioeconomic inequalities due to rapid and unplanned urbanization. These processes have resulted in the creation of poor urban areas lacking basic sanitation, water, and hygiene facilities, and subjacent public health issues such as the spread of waterborne diseases. A system for the demarcation of disease transmission areas already exists, but the traditional framework is less appropriate in sub-Saharan Africa, making it necessary to divide these urban areas more adequately. In addition, the construction of frameworks and tools more specific to waterborne disease-related issues is essential. We propose restructuring sub-Saharan urban areas into more specific areas of exposure to waterborne diseases and associated exposomes, and then use this restructuring of urban areas of exposure to waterborne diseases in a conceptual framework that takes into account causes of exposure, impacts, and interventions. The division of urban areas into public, domestic, and individual exposure areas facilitates a more straightforward understanding of the dynamics of waterborne exposomes. Moreover, the inclusion of this division in the driving force–pressure–state–exposure–effect–action framework allows an effective stratified implementation of urban public health policies.

Summary

Key Message
Public, domestic and individual as sub-sections of urban transmission domain of waterborne diseases in sub-Saharan Africa may constitute a relevant approach for public health interventions.

Citations

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Recent advances and issues in the application of activated carbon for water treatment in Africa: A systematic review (2007–2022)
Joel B. Njewa, Victor O. Shikuku
Applied Surface Science Advances.2023; 18: 100501. CrossRef
Conceptualization of the Transmission Dynamic of Faecal-Orally Transmitted Diseases in Urban Exposome of Sub-Saharan Africa
Alexandre Zerbo, Rafael Castro Delgado, Pedro Arcos González
Risk Management and Healthcare Policy.2022; Volume 15: 1959. CrossRef

Maternal mental health in Africa during the COVID-19 pandemic: a neglected global health issue: Kobi V. Ajayi, Elizabeth Wachira, Obasanjo Afolabi Bolarinwa, Beulah D. Suleman; Epidemiol Health. 2021;43:e2021078. Published online October 6, 2021; DOI: https://doi.org/10.4178/epih.e2021078

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Abstract

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted mental health and well-being around the globe. Public health measures to control the virus’s rapid spread, such as physical distancing, social isolation, lockdown, restricted movements, and quarantine, caused fear and panic in the general population. Although pandemic-related stressors have been reported, changes that occur during the perinatal period compounded by those made to obstetric care guidelines may put pregnant and postpartum mothers at an increased risk of poor mental health. While an abundance of research has examined the impact of the pandemic on maternal mental health in developed nations such as Europe and America, very few studies have done so in the African continent. Considering that Africa has prominently weak health systems, poor mental health policies and infrastructure, high poverty rates, and unreliable maternal care, the pandemic is expected to have dire consequences on maternal mental health in the region. As such, multipronged mental health interventions and strategies that consider the heterogeneity within and between African regions must be developed. Doing so will close existing and widening global health disparities to achieve the United Nations Sustainable Development Goals by 2030.

Summary

Key Message
Despite the adverse psychological impact of the COVID-19 pandemic on maternal mental health globally, little is known about its effect in Africa. As of the time of this study, only four research studies have been conducted in Nigeria, Ethiopia, and Ghana, investigating the psychological sequelae of the pandemic among pregnant and postpartum women in Africa. This study calls for urgent multipronged maternal mental health interventions and psychosocial support that consider the heterogeneity within and between African regions.

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Poor sleep quality and suicidal ideation among pregnant women during COVID-19 in Ethiopia: systematic review and meta-analysis
Aragaw Asfaw Hasen, Abubeker Alebachew Seid, Ahmed Adem Mohammed
PeerJ.2023; 11: e16038. CrossRef
Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study
Sabrina Pilav, Abigail Easter, Sergio A. Silverio, Kaat De Backer, Sushma Sundaresh, Sara Roberts, Louise M. Howard
International Journal of Environmental Research and Public Health.2022; 19(4): 1975. CrossRef
Generalized Anxiety Disorder and Its Associated Factors Among Pregnant Women During COVID-19 at Public Health Facilities of East Gojjam Zone, 2020: A Multi-Center Cross-Sectional Study
Keralem Anteneh Bishaw, Addisu Andalem, Haile Amha, Tirusew wondie
Frontiers in Global Women's Health.2022;[Epub] CrossRef

Brief Communication

Cancer incidence in the Tobruk area, eastern Libya: first results from Tobruk Medical Centre: Faisal Ismail, Ahmed G. Elsayed, Islam El-Garawani, Eman Abdelsameea; Epidemiol Health. 2021;43:e2021050. Published online August 3, 2021; DOI: https://doi.org/10.4178/epih.e2021050

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Abstract

OBJECTIVES
Cancer is a major cause of morbidity and mortality worldwide, and it is an increasing problem in developing countries. Estimation of the incidence of cancer is important, especially in regions with limited epidemiological data on cancer. Therefore, the aim of this study was to provide an updated report on the incidence of cancers in the Tobruk region in eastern Libya.

METHODS

Data on cancer patients from the records of the Department of Histopathology of Tobruk Medical Centre from January 2013 to June 2020 were included.

RESULTS

In total, 402 cases were recorded. Men patients accounted for 30.3% (n=122) of cases, and women patients represented 69.6% (n=280). The overall mean age at the time of the first diagnosis was 49.0±17.1 years. The most common malignancies were breast and uterine cancer in women (18.4%, n=74; 15.9%, n=64, respectively), colorectal cancer (11.6%, n=47; 26 in women and 21 in men), bladder cancer (8.2%, n=33; 8 in women and 25 in men), and thyroid cancer (8.0%, n=32; 23 in women and 9 in men).

CONCLUSIONS

Breast and uterine cancers were the most common cancers in women, and bladder and colorectal cancer were the most common cancers in men, followed by colorectal cancer in both genders. These data will help health authorities launch preventive plans for cancer in the region. Further studies to identify aetiological factors and cancer-related risk factors need to be conducted in the region.

Summary

Key Message
Cancer incidence in the Tobruk area, eastern Libya: first results from Tobruk Medical Centre; cancer is a major cause of morbidity and mortality worldwide and so in Libya; this is an updated report on the incidence of cancers in the Tobruk region in eastern Libya.

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Libyan cancer patients at King Hussein Cancer Center for more than a decade, the current situation, and a future vision
Madiha Erashdi, Abdallah Al-Ani, Asem Mansour, Maysa Al-Hussaini
Frontiers in Oncology.2023;[Epub] CrossRef
Cancer Patterns among Patients Admitted to the Oncology Department at Benghazi Medical Center, Libya (2013-2017)
Naeima Hussein, Fathi Omar
Journal of Medicine and Health Studies.2023; : 23. CrossRef

Systematic Review

Prevalence of high-risk HPV genotypes in sub-Saharan Africa according to HIV status: a 20-year systematic review: Jude Ogechukwu Okoye, Chukwudi Amaechi Ofodile, Oluwaseun Kelechi Adeleke, Okechi Obioma; Epidemiol Health. 2021;43:e2021039. Published online May 25, 2021; DOI: https://doi.org/10.4178/epih.e2021039

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Abstract

OBJECTIVES
This review assessed the rate of high-risk human papillomavirus (HPV) infection among women living in sub-Saharan Africa. It also determined the prevalence of high-risk HPV (hrHPV) among human immunodeficiency virus (HIV) seropositive (HIV+) and seronegative (HIV-) women in sub-Saharan Africa, pre-2010 and post-2010.

METHODS

In this systematic review, Google Scholar, PubMed Central, and Embase were searched to identify cohort and case-control studies that investigated the relationship between HIV and HPV infection. The database searches yielded 17 studies published between 1999 and 2018.

RESULTS

In the general population, the prevalence of any HPV/multiple HPV infections was higher among HIV+ (53.6/22.6%) than among HIV- women (26.5/7.3%) with odds ratios of 3.22 and 3.71, respectively (95% confidence interval, 3.00 to 3.42 and 2.39 to 5.75, p< 0.001). The prevalent HPV genotypes among HIV+ and HIV- women diagnosed with invasive cervical cancer (ICC) were HPV-16/18 and HPV-45. The prevalence of HPV-16, HPV-18, and HPV-45 was lower in 1999-2010 (3.8, 1.7, and 0.8%, respectively) than in 2011-2018 (19.1, 6.0, and 3.6%, respectively). Among women diagnosed with ICC, HIV+ women had a higher prevalence of HPV-56, HPV-31, and HPV-51 (7.3, 5.3, and 3.3%, respectively) than HIV- women (1.3, 2.2, and 0.4%, p< 0.001, p= 0.050, and p= 0.013, respectively).

CONCLUSIONS

The prevalence of HPV infection, multiple HPV infections, and non-vaccine HPV types were higher among HIV+ women than among HIV- women in sub-Saharan Africa. Although HIV infection influences the distribution of HPV types, this study suggests that cervical cancer incidence in sub-Saharan Africa is primarily driven by the prevalence of vaccine hrHPVs, especially HPV-16 and HPV-18.

Summary

Key Message
Despite increasing awareness of Human papillomavirus (HPV) among women and availability of HPV vaccines, mounting evidence shows that the age-standardized incidence rate of cervical cancer is increasing in sub-Saharan Africa. This review revealed the influences of some viruses on the trends of the disease between 1999-2010 and 2011-2018.

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Simon M. Manga, Yuanfan Ye, Kathleen L. Nulah, Florence Manjuh, Joel Fokom-Domgue, Isabel Scarinci, Alan N. Tita
Cancers.2024; 16(2): 243. CrossRef
Fighting cervical cancer in Africa: Taking a closer look at human papillomavirus 35
Sophia U. Okeke
African Journal of Laboratory Medicine.2024;[Epub] CrossRef
HIV status and knowledge of cervical cancer among women in Ghana
Nancy Innocentia Ebu Enyan, Sebastian Ken-Amoah, Derek Anamaale Tuoyire, Kafui Patrick Akakpo, Elizabeth Agyare, Dorcas Obiri-Yeboah
BMC Women's Health.2024;[Epub] CrossRef
The role of multiple high‐risk human papillomavirus infection on the persistence recurrence of high‐grade cervical lesions after standard treatment: A systematic review and a meta‐analysis
Chiara Cassani, Mattia Dominoni, Marianna Francesca Pasquali, Barbara Gardella, Arsenio Spinillo
Acta Obstetricia et Gynecologica Scandinavica.2024;[Epub] CrossRef
Comparison of human papillomavirus‐based cervical cancer screening strategies in Tanzania among women with and without HIV
Crispin Kahesa, Louise T. Thomsen, Ditte S. Linde, Bariki Mchome, Johnson Katanga, Patricia Swai, Rachel Manongi, Myassa Kjaerem, Thomas Iftner, Marianne Waldstrøm, Julius Mwaiselage, Vibeke Rasch, Susanne K. Kjær
International Journal of Cancer.2023; 152(4): 686. CrossRef
Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries
Jessica Joseph, Owen Demke, Lola Ameyan, Joseph Bitilinyu-Bango, Blandine Bourgoin, Mamadou Diop, Babacar Guèye, Jibrin Kama, Marvin Lubega, Bernard Madzima, Tatenda Maparo, Tasimba Mhizha, Andrew Musoke, Susan Nabadda, Twambilire Phiri, Timothy Tchereni,
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Marian Kaoma, Oladapo Olayemi, Mwila Hilton Mwaba, Kapembwa Sikwewa
BMC Women's Health.2023;[Epub] CrossRef
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Mkunde Chachage, Ajay P. Parikh, Anifrid Mahenge, Emmanuel Bahemana, Jonathan Mnkai, Wilbert Mbuya, Ruby Mcharo, Lucas Maganga, Jaqueline Mwamwaja, Reginald Gervas, Hannah Kibuuka, Jonah Maswai, Valentine Singoei, Michael Iroezindu, Abiola Fasina, Allahna
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Editorial

What do we really fear? The epidemiological characteristics of Ebola and our preparedness: Moran Ki; Epidemiol Health. 2014;36:e2014014. Published online August 18, 2014; DOI: https://doi.org/10.4178/epih/e2014014

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Abstract Summary PDF Supplementary Material

Abstract

Ebola virus disease (hereafter Ebola) has a high fatality rate; currently lacks a treatment or vaccine with proven safety and efficacy, and thus many people fear this infection. As of August 13, 2014, 2,127 patients across four West African countries have been infected with the Ebola virus over the past nine months. Among these patients, approximately 1 in 2 has subsequently died from the disease. In response, the World Health Organization has declared the Ebola outbreak in West Africa to be a Public Health Emergency of International Concern. However, Ebola is only transmitted by patients who already present symptoms of the disease, and infection only occurs upon direct contact with the blood or body fluids of an Ebola patient. Consequently, transmission of the outbreak can be contained through careful monitoring for fever among persons who have visited, or come into contact with persons from, the site of the outbreak. Thus, patients suspected of presenting symptoms characteristic of Ebola should be quarantined. To date, South Korea is not equipped with the special containment clinical units and biosafety level 4 facilities required to contain the outbreak of a fatal virus disease, such as Ebola. Therefore, it is necessary for South Korea to make strategies to the outbreak by using present facilities as quickly as possible. It is also imperative that the government establish suitable communication with its citizens to prevent the spread of uninformed fear and anxiety regarding the Ebola outbreak.

Summary

Korean summary
에볼라 바이러스병은 치명률이 높고 효과와 안전성을 모두 검증받은 치료제나 백신이 없어 많은 사람들이 두려워하고 있는 질환이다. 이번에 서아프리카에서 9개월째 지속된 유행으로 8월 13일까지 4개국에서 2127명의 환자가 발생하였고 1145명이 사망하여 2명중 1명꼴인 높은 치명률을 보이고 있다. 이에 WHO에서는 국제보건긴급상황을 선포하였다. 하지만 에볼라 바이러스는 증상이 나타난 이후에 전염되며 환자의 혈액이나 체액에 접촉한 경우에만 감염이 된다. 따라서 유행지역을 방문하였거나 접촉한 사람을 대상으로 발열감시와 함께 환자 격리를 철저히 시행한다면 유행 전파를 막을 수 있다. 한국은 아직 에볼라 바이러스와 같은 질환에 적합한 격리병상이나 실험실 안전 4등급 시설이 없다. 이에 대한 대비를 빠른 시간에 마련하여 대응하는 것이 필요하며, 국민과의 소통을 통해서 막연한 불안과 두려움을 예방하는 것이 무엇보다 중요하다.

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