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Fulltext Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review

Damulak PP, Ismail S, Abdul Manaf R, Mohd Said S, Agbaji O

Int J Environ Res Public Health, 2021 03 03;18(5).
PMID: 33802322 DOI: 10.3390/ijerph18052477

Optimal adherence to antiretroviral therapy (ART) remains the bedrock of effective therapy and management of human immunodeficiency virus (HIV). This systematic review examines the effect of interventions in improving ART adherence in sub-Saharan Africa (SSA), which bears the largest global burden of HIV infection. In accordance with PRISMA guidelines, and based on our inclusion and exclusion criteria, PUBMED, MEDLINE, and Google Scholar databases were searched for published studies on ART adherence interventions from 2010 to 2019. Thirty-one eligible studies published between 2010 to 2019 were identified, the categories of interventions were structural, behavioral, biological, cognitive, and combination. Study characteristics varied across design, intervention type, intervention setting, country, and outcome measurements. Many of the studies were behavioral interventions conducted in hospitals with more studies being randomized controlled trial (RCT) interventions. Despite the study variations, twenty-four studies recorded improvements. Notwithstanding, more quality studies such as RCTs should be conducted, especially among key affected populations (KAPs) to control transmission of resistant strains of the virus. Reliable objective measures of adherence should replace the conventional subjective self-report. Furthermore, long-term interventions with longer duration should be considered when evaluating the effectiveness of interventions.

Matched MeSH terms: Africa South of the Sahara/epidemiology
Unheard voices of global surgery - trauma services in sub-Saharan Africa: a correspondence

Mehta A, Wireko AA, Ohenewaa Tenkorang P, Ng JC, Rahman TA, Sikora V, et al.

Int J Surg, 2023 Mar 01;109(3):521-522.
PMID: 36906789 DOI: 10.1097/JS9.0000000000000145
Matched MeSH terms: Africa South of the Sahara
Fulltext Effectiveness of health education interventions to improve malaria knowledge and insecticide-treated nets usage among populations of sub-Saharan Africa: systematic review and meta-analysis

Onyinyechi OM, Mohd Nazan AIN, Ismail S

Front Public Health, 2023;11:1217052.
PMID: 37601202 DOI: 10.3389/fpubh.2023.1217052

INTRODUCTION: Malaria health education intervention is a community-directed approach that has long been considered important in preventing malaria in sub-Saharan Africa. However, its effectiveness is being questioned due to a lack of strong evidence. We aim to synthesize the evidence of the impact of health education on malaria knowledge and insecticide-treated nets (ITN) usage. Specifically, we analyzed the odds of correctly answering malaria-related questions and the odds of using ITN between the intervention and control groups.
METHODS: Experimental and observational studies conducted in sub-Saharan Africa between 2000 and 2021 which had quantitatively evaluated the impact of health education interventions on malaria knowledge and ITN usage were included in the review.
RESULTS: A total of 11 studies (20,523 participants) were included. Four studies used educational interventions to teach appropriate ITN strategies and promote ITN usage. Two others focused on improving knowledge of malaria transmission, prevention, treatment, and its signs and symptoms. The remaining five studies assessed both ITN use and malaria knowledge. Of these, 10 were eligible for meta-analysis. On average, the odds of a person in the intervention group reporting better malaria knowledge (odds ratio 1.30, 95% CI: 1.00 to 1.70, p = 0.05) and higher ITN usage (odds ratio 1.53, 95% CI: 1.02 to 2.29, p = 0.004) increased significantly after receiving health education interventions compared to those in the control group. The odds of ITN usage also substantially increased when the interventions were based on a theory or model (odds ratio 5.27, 95% CI: 3.24 to 8.58, p = 0.05).
DISCUSSION: Our review highlights sub-Saharan Africa's various health education strategies to curb malaria over the past two decades. Meta-analysis findings show that health education interventions are moderately effective in improving malaria knowledge and ITN usage and have contributed to the effort of global malaria strategy.

Matched MeSH terms: Africa South of the Sahara
Gender disparity in access to education, under-5 mortality, and economic growth in sub-Saharan Africa

Wang L, Nwabuoku M, Zhang J, Osabohien R

Afr J Reprod Health, 2023 Dec 31;27(12):27-35.
PMID: 38158859 DOI: 10.29063/ajrh2023/v27i12.3

This paper empirically analyses the impact of gender disparity in access to education and under 5 mortality on economic growth in selected sub-Saharan African (SSA) countries from the period 2005 - 2020. The study engaged a panel data of 17 selected SSA countries sourced from the World Development Indicators (WDI) and the United Nations Institute for Statistics (UNIS) and applied the instrumental variable generalised method of moments analytical approach. The result shows that the interaction between gender parity in access to education and primary school enrolment has a significant impact on economic growth. The study concludes that policies to promote gender parity in access to education would be of paramount importance to increase economic growth towards the actualisation of sustainable development goal related to inclusive and equitable quality education and the promotion of lifelong learning opportunities (SDG4) in SSA countries.

Matched MeSH terms: Africa South of the Sahara
Fulltext COVID-19 Lethality in Sub-Saharan Africa and Helminth Immune Modulation

Fonte L, Acosta A, Sarmiento ME, Ginori M, García G, Norazmi MN

Front Immunol, 2020;11:574910.
PMID: 33117371 DOI: 10.3389/fimmu.2020.574910
Matched MeSH terms: Africa South of the Sahara/epidemiology
Patient Care and Treatment Strategies for Skin Diseases in Sub-Saharan Africa: Role of Traditional and Western Medicines

Sharma A, Sundaram S, Malviya R, Verma S, Fuloria NK, Fuloria S, et al.

Infect Disord Drug Targets, 2023;23(3):e190922208916.
PMID: 36121085 DOI: 10.2174/1871526522666220919105643

The perspective of the people of Sub-Saharan Africa (SSA) toward both traditional and western healthcare systems varies. The goal of the current study is to examine the SSA's unique skin disease health care system. This study comprises numerous research that sought to examine how the general public feels about the SSA's current healthcare system. In this review, common skin conditions, such as atopic dermatitis, buruli ulcers, dermatophytosis, and scabies, are addressed. According to this report, government agencies must pay particular attention to skin illnesses in SSA and raise public awareness. Availability of medical care, socioeconomic factors, degree of education, and other factors influence patients' attitudes toward traditional and western health care differently in different geographic areas. Facts suggest that self-medication is the preference of the majority of patients before seeking dermatological care. The present study concludes that the magnitude of skin diseases is neglected or underestimated in many regions of SSA. Also, western healthcare facilities of many regions of SSA are not up to the mark. The present study recommends that proper access to the health care system and awareness about skin diseases through various government programs can be helpful in the regulation of skin disorders among people of SSA.

Matched MeSH terms: Africa South of the Sahara/epidemiology
Fulltext Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018

Haeuser E, Serfes AL, Cork MA, Yang M, Abbastabar H, Abhilash ES, et al.

BMC Med, 2022 Dec 19;20(1):488.
PMID: 36529768 DOI: 10.1186/s12916-022-02639-z

BACKGROUND: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA.
METHODS: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units.
RESULTS: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group.
CONCLUSIONS: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Matched MeSH terms: Africa South of the Sahara/epidemiology
Renewable energy and environmental quality: A second-generation panel evidence from the Sub Saharan Africa (SSA) countries

Salahuddin M, Habib MA, Al-Mulali U, Ozturk I, Marshall M, Ali MI

Environ Res, 2020 12;191:110094.
PMID: 32846170 DOI: 10.1016/j.envres.2020.110094

This study employs dynamic panel data for 34 Sub Saharan Africa (SSA) countries for the period 1984-2016 to estimate the effects of renewable energy on environmental quality measured by three indicators, namely, per capita CO2 emissions, energy intensity (EI) and Aggregate National Savings (ANS). The study leveraged a battery of second-generation econometric tests and estimation and causality methods to obtain the coefficients between the regressed and the regressors. Results reveal that use of renewable energy reduces CO2 emissions and energy intensity while it enhances ANS. Economic growth still seems to be expensive for the region as it stimulates CO2 emissions. However, it has a positive effect on ANS. As expected, fossil fuels exacerbate CO2 emissions and energy intensity. FDI is found to be detrimental for the environment of SSA region with its positive significant coefficient on CO2 emissions. Financial development is reported to reduce CO2 emissions. Some causal links between variables are also noted.

Matched MeSH terms: Africa South of the Sahara
Fulltext Historic Sampling of a Vanishing Beast: Population Structure and Diversity in the Black Rhinoceros

Sánchez-Barreiro F, De Cahsan B, Westbury MV, Sun X, Margaryan A, Fontsere C, et al.

Mol Biol Evol, 2023 Sep 01;40(9).
PMID: 37561011 DOI: 10.1093/molbev/msad180

The black rhinoceros (Diceros bicornis L.) is a critically endangered species historically distributed across sub-Saharan Africa. Hunting and habitat disturbance have diminished both its numbers and distribution since the 19th century, but a poaching crisis in the late 20th century drove them to the brink of extinction. Genetic and genomic assessments can greatly increase our knowledge of the species and inform management strategies. However, when a species has been severely reduced, with the extirpation and artificial admixture of several populations, it is extremely challenging to obtain an accurate understanding of historic population structure and evolutionary history from extant samples. Therefore, we generated and analyzed whole genomes from 63 black rhinoceros museum specimens collected between 1775 and 1981. Results showed that the black rhinoceros could be genetically structured into six major historic populations (Central Africa, East Africa, Northwestern Africa, Northeastern Africa, Ruvuma, and Southern Africa) within which were nested four further subpopulations (Maasailand, southwestern, eastern rift, and northern rift), largely mirroring geography, with a punctuated north-south cline. However, we detected varying degrees of admixture among groups and found that several geographical barriers, most prominently the Zambezi River, drove population discontinuities. Genomic diversity was high in the middle of the range and decayed toward the periphery. This comprehensive historic portrait also allowed us to ascertain the ancestry of 20 resequenced genomes from extant populations. Lastly, using insights gained from this unique temporal data set, we suggest management strategies, some of which require urgent implementation, for the conservation of the remaining black rhinoceros diversity.

Matched MeSH terms: Africa South of the Sahara
Fulltext Determinants of antiretroviral therapy coverage in Sub-Saharan Africa

Furuoka F, Hoque MZ

PeerJ, 2015;3:e1496.
PMID: 26664812 DOI: 10.7717/peerj.1496

Among 35 million people living with the human immunodeficiency virus (HIV) in 2013, only 37% had access to antiretroviral therapy (ART). Despite global concerted efforts to provide the universal access to the ART treatment, the ART coverage varies among countries and regions. At present, there is a lack of systematic empirical analyses on factors that determine the ART coverage. Therefore, the current study aimed to identify the determinants of the ART coverage in 41 countries in Sub-Saharan Africa. It employed statistical analyses for this purpose. Four elements, namely, the HIV prevalence, the level of national income, the level of medical expenditure and the number of nurses, were hypothesised to determine the ART coverage. The findings revealed that among the four proposed determinants only the HIV prevalence had a statistically significant impact on the ART coverage. In other words, the HIV prevalence was the sole determinant of the ART coverage in Sub-Saharan Africa.

Matched MeSH terms: Africa South of the Sahara
Fulltext Is hardship during migration a determinant of HIV infection? Results from the ANRS PARCOURS study of sub-Saharan African migrants in France

Desgrees-du-Lou A, Pannetier J, Ravalihasy A, Le Guen M, Gosselin A, Panjo H, et al.

AIDS, 2016 Feb 20;30(4):645-56.
PMID: 26558722 DOI: 10.1097/QAD.0000000000000957

In Europe, sub-Saharan African migrants are a key population for HIV infection. We analyse how social hardships during settlement in France shape sexual partnerships and HIV risk.

Matched MeSH terms: Africa South of the Sahara
A hybrid ensemble approach to accelerate the classification accuracy for predicting malnutrition among under-five children in sub-Saharan African countries

Khan MNA, Yunus RM

Nutrition, 2023 Apr;108:111947.
PMID: 36641887 DOI: 10.1016/j.nut.2022.111947

BACKGROUND: The proper intake of nutrients is essential to the growth and maturation of youngsters. In sub-Saharan Africa, 1 in 7 children dies before age 5 y, and more than a third of these deaths are attributed to malnutrition. The main purpose of this study was to develop a majority voting-based hybrid ensemble (MVBHE) learning model to accelerate the prediction accuracy of malnutrition data of under-five children in sub-Saharan Africa.
METHODS: This study used available under-five nutritional secondary data from the Demographic and Health Surveys performed in sub-Saharan African countries. The research used bagging, boosting, and voting algorithms, such as random forest, decision tree, eXtreme Gradient Boosting, and k-nearest neighbors machine learning methods, to generate the MVBHE model.
RESULTS: We evaluated the model performances in contrast to each other using different measures, including accuracy, precision, recall, and the F1 score. The results of the experiment showed that the MVBHE model (96%) was better at predicting malnutrition than the random forest (81%), decision tree (60%), eXtreme Gradient Boosting (79%), and k-nearest neighbors (74%).
CONCLUSIONS: The random forest algorithm demonstrated the highest prediction accuracy (81%) compared with the decision tree, eXtreme Gradient Boosting, and k-nearest neighbors algorithms. The accuracy was then enhanced to 96% using the MVBHE model. The MVBHE model is recommended by the present study as the best way to predict malnutrition in under-five children.

Matched MeSH terms: Africa South of the Sahara
Why Women Are Averse to Facility Delivery in Northwest Nigeria: A Qualitative Inquiry

Tukur I, Chan CK, Tinsu T, Muhammed-Baba T, Aderemi Ijaiya M

Iran J Public Health, 2016 May;45(5):586-95.
PMID: 27398331

In many sub-Saharan African countries the rate of antenatal care (ANC) has been increased but skilled birth attendance rate is still low. The objective of this study was to evaluate the reasons why women prefer home delivery when facility based delivery is available at minimal cost.

Matched MeSH terms: Africa South of the Sahara
Fulltext Prevalence, distribution, and social determinants of tobacco use in 30 sub-Saharan African countries

Sreeramareddy CT, Pradhan PM, Sin S

BMC Med, 2014;12:243.
PMID: 25518855 DOI: 10.1186/s12916-014-0243-x

BACKGROUND: Although the Framework Convention on Tobacco Control prioritizes monitoring of tobacco use by population-based surveys, information about the prevalence and patterns of tobacco use in sub-Saharan Africa is limited. We provide country-level prevalence estimates for smoking and smokeless tobacco (SLT) use and assess their social determinants.
METHODS: We analyzed population-based data of the most recent Demographic Health Surveys performed between 2006 and 2013 involving men and women in 30 sub-Saharan African countries. Weighted country-level prevalence rates were estimated for 'current smoking' (cigarettes, pipe, cigars, etc.) and 'current SLT use' (chewing, snuff, etc.). From the pooled datasets for men and women, social determinants of smoking and SLT use were assessed through multivariate analyses using a dummy country variable as a control and by including a within-country sample weight for each country.
RESULTS: Among men, smoking prevalence rates were high in Sierra Leone (37.7%), Lesotho (34.1%), and Madagascar (28.5%); low (<10%) in Ethiopia, Benin, Ghana, Nigeria, and Sao Tome & Principe; the prevalence of SLT use was <10% in all countries except for Madagascar (24.7%) and Mozambique (10.9%). Among women, smoking and SLT prevalence rates were <5% in most countries except for Burundi (9.9%), Sierra Leone (6%), and Namibia (5.9%) (smoking), and Madagascar (19.6%) and Lesotho (9.1%) (SLT use). The proportion of females who smoked was lower than SLT users in most countries. Older age was strongly associated with both smoking and SLT use among men and women. Smoking among both men and women was weakly associated, but SLT use was strongly associated, with education. Similarly, smoking among men and women was weakly associated, but SLT use was strongly associated, with the wealth index. Smoking and SLT use were also associated with marital status among both men and women, as well as with occupation (agriculturists and unskilled workers).
CONCLUSIONS: Prevalence of smoking among women was much lower than in men, although the social patterns of tobacco use were similar to those in men. Tobacco control strategies should target the poor, not/least educated, and agricultural and unskilled workers, who are the most vulnerable social groups in sub-Saharan Africa.

Matched MeSH terms: Africa South of the Sahara/epidemiology
15 years of APOC--a lifetime of public health evidence

Allotey P, Amazigo U, Adjei S, Seddoh A, Lusamba-Dikassa PS

Lancet, 2012 Oct 20;380(9851):1361-3.
PMID: 23084441 DOI: 10.1016/S0140-6736(12)60723-5
Matched MeSH terms: Africa South of the Sahara/epidemiology
Fulltext Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: a WHO-coordinated, prospective, international, observational cohort study

Kleinschmidt I, Bradley J, Knox TB, Mnzava AP, Kafy HT, Mbogo C, et al.

Lancet Infect Dis, 2018 Jun;18(6):640-649.
PMID: 29650424 DOI: 10.1016/S1473-3099(18)30172-5

BACKGROUND: Scale-up of insecticide-based interventions has averted more than 500 million malaria cases since 2000. Increasing insecticide resistance could herald a rebound in disease and mortality. We aimed to investigate whether insecticide resistance was associated with loss of effectiveness of long-lasting insecticidal nets and increased malaria disease burden.
METHODS: This WHO-coordinated, prospective, observational cohort study was done at 279 clusters (villages or groups of villages in which phenotypic resistance was measurable) in Benin, Cameroon, India, Kenya, and Sudan. Pyrethroid long-lasting insecticidal nets were the principal form of malaria vector control in all study areas; in Sudan this approach was supplemented by indoor residual spraying. Cohorts of children from randomly selected households in each cluster were recruited and followed up by community health workers to measure incidence of clinical malaria and prevalence of infection. Mosquitoes were assessed for susceptibility to pyrethroids using the standard WHO bioassay test. Country-specific results were combined using meta-analysis.
FINDINGS: Between June 2, 2012, and Nov 4, 2016, 40 000 children were enrolled and assessed for clinical incidence during 1·4 million follow-up visits. 80 000 mosquitoes were assessed for insecticide resistance. Long-lasting insecticidal net users had lower infection prevalence (adjusted odds ratio [OR] 0·63, 95% CI 0·51-0·78) and disease incidence (adjusted rate ratio [RR] 0·62, 0·41-0·94) than did non-users across a range of resistance levels. We found no evidence of an association between insecticide resistance and infection prevalence (adjusted OR 0·86, 0·70-1·06) or incidence (adjusted RR 0·89, 0·72-1·10). Users of nets, although significantly better protected than non-users, were nevertheless subject to high malaria infection risk (ranging from an average incidence in net users of 0·023, [95% CI 0·016-0·033] per person-year in India, to 0·80 [0·65-0·97] per person year in Kenya; and an average infection prevalence in net users of 0·8% [0·5-1·3] in India to an average infection prevalence of 50·8% [43·4-58·2] in Benin).
INTERPRETATION: Irrespective of resistance, populations in malaria endemic areas should continue to use long-lasting insecticidal nets to reduce their risk of infection. As nets provide only partial protection, the development of additional vector control tools should be prioritised to reduce the unacceptably high malaria burden.
FUNDING: Bill & Melinda Gates Foundation, UK Medical Research Council, and UK Department for International Development.

Matched MeSH terms: Africa South of the Sahara/epidemiology
An analysis of the development assistance for health (DAH) allocations for STD control in Africa

Furuoka F, Hoque MZ, Jacob RI, Ziegenhain P

Health Econ Policy Law, 2020 Oct;15(4):458-476.
PMID: 30968812 DOI: 10.1017/S1744133119000197

The Sustainable Development Goals set by the United Nations recognize the importance of making progress in the eradication and treatment of sexually transmitted deceases (STD). STD are among the most widespread diseases in the world and have the highest prevalence in Sub-Saharan Africa. The current study explored the associations between the allocation of the development assistance for health (DAH) in 54 African countries and key development indicators - STD incidence, Gross Domestic Product per capita, health expenditure, and life expectancy at birth. It employed descriptive statistical methods, the matrix scatter plot analysis and the Pearson correlation test for this purpose. The findings indicated that there was a considerable increase in the volume of the DAH given to control and prevent STD in Africa over the period of 2002-2011. A statistically significant positive association was detected between the STD incidence and the health aid allocations. At the same time, the imbalance in the distribution of the health aid between the major and minor aid recipients in the continent increased. The study concludes by discussing policy implications that can be drawn from these findings.

Matched MeSH terms: Africa South of the Sahara
Fulltext A Cross-Species Gene Expression Marker-Based Genetic Map and QTL Analysis in Bambara Groundnut

Chai HH, Ho WK, Graham N, May S, Massawe F, Mayes S

Genes (Basel), 2017 Feb 22;8(2).
PMID: 28241413 DOI: 10.3390/genes8020084

Bambara groundnut (Vigna subterranea (L.) Verdc.) is an underutilised legume crop, which has long been recognised as a protein-rich and drought-tolerant crop, used extensively in Sub-Saharan Africa. The aim of the study was to identify quantitative trait loci (QTL) involved in agronomic and drought-related traits using an expression marker-based genetic map based on major crop resources developed in soybean. The gene expression markers (GEMs) were generated at the (unmasked) probe-pair level after cross-hybridisation of bambara groundnut leaf RNA to the Affymetrix Soybean Genome GeneChip. A total of 753 markers grouped at an LOD (Logarithm of odds) of three, with 527 markers mapped into linkage groups. From this initial map, a spaced expression marker-based genetic map consisting of 13 linkage groups containing 218 GEMs, spanning 982.7 cM (centimorgan) of the bambara groundnut genome, was developed. Of the QTL detected, 46% were detected in both control and drought treatment populations, suggesting that they are the result of intrinsic trait differences between the parental lines used to construct the cross, with 31% detected in only one of the conditions. The present GEM map in bambara groundnut provides one technically feasible route for the translation of information and resources from major and model plant species to underutilised and resource-poor crops.

Matched MeSH terms: Africa South of the Sahara
Wood fuel consumption and mortality rates in Sub-Saharan Africa: Evidence from a dynamic panel study

Sulaiman C, Abdul-Rahim AS, Chin L, Mohd-Shahwahid HO

Chemosphere, 2017 Mar 06;177:224-231.
PMID: 28292722 DOI: 10.1016/j.chemosphere.2017.03.019

This study examined the impact of wood fuel consumption on health outcomes, specifically under-five and adult mortality in Sub-Saharan Africa, where wood usage for cooking and heating is on the increase. Generalized method of moment (GMM) estimators were used to estimate the impact of wood fuel consumption on under-five and adult mortality (and also male and female mortality) in the region. The findings revealed that wood fuel consumption had significant positive impact on under-five and adult mortality. It suggests that over the studied period, an increase in wood fuel consumption has increased the mortality of under-five and adult. Importantly, it indicated that the magnitude of the effect of wood fuel consumption was more on the under-five than the adults. Similarly, assessing the effect on a gender basis, it was revealed that the effect was more on female than male adults. This finding suggests that the resultant mortality from wood smoke related infections is more on under-five children than adults, and also are more on female adults than male adults. We, therefore, recommended that an alternative affordable, clean energy source for cooking and heating should be provided to reduce the wood fuel consumption.

Matched MeSH terms: Africa South of the Sahara
Fulltext Fish Acquisition and Consumption in the African Great Lakes Region through a Food Environment Lens: A Scoping Review

de Bruyn J, Wesana J, Bunting SW, Thilsted SH, Cohen PJ

Nutrients, 2021 Jul 14;13(7).
PMID: 34371918 DOI: 10.3390/nu13072408

Effective actions for the fishery and aquaculture sectors to contribute toward improving nutrition rely on an understanding of the factors influencing fish intake, particularly amongst vulnerable populations. This scoping review synthesises evidence from 33 studies in the African Great Lakes Region to examine the influence of food environments on fish acquisition and consumption. We identified only two studies that explicitly applied a food environment framework and none that linked policy conditions with the contribution of fish to diets. Economic access to fish was represented in the largest number of included studies (21 studies), followed by preferences, acceptability and desirability of fish (17 studies) and availability and physical access (14 studies). Positive perceptions of taste and low cost, relative to other animal-source foods, were drivers of fish purchases in many settings; however, limited physical and economic access were frequently identified as preventing optimal intake. In lakeside communities, fish were increasingly directed toward external markets which reduced the availability and affordability of fish for local households. Few studies considered intra-household variations in fish access according to age, gender or physiological status, which represents an important knowledge gap. There is also scope for future research on seasonal influences on fish access and the design and rigorous evaluation of programmes and policies that address one or more constraints of availability, cost, convenience and preferences.

Matched MeSH terms: Africa South of the Sahara

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