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Background: The global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health services beyond those directly addressing HIV and AIDS. This systematised narrative review describes the effects of PMTCT programs on other health care services and the implications for improving health systems in SSA as reported in the existing articles and scientific literature. The following objectives framed our review: 1. To describe the effects of PMTCT on health care services and systems in SSA and assess whether the PMTCT has strengthened or weakened health systems in SSA 2. To describe the integration of PMTCT and its extent within broader programs and health systems. Methods: Articles published in English and French over the period 1st January 2007 (the year of publication of WHO/UNICEF guidelines on global scale-up of the PMTCT) to 31 November 2016 on PMTCT programs in SSA were sought through searches of electronic databases (Medline and Google Scholar). Articles describing the impact (positive and negative effects) of PMTCT on other health care services and those describing its integration in health systems in SSA were eligible for inclusion. We assessed 6223 potential papers, reviewed 225, and included 57. Results: The majority of selected articles offered arguments for increased health services utilisation, notably of ante-natal care, and some evidence of beneficial synergies between PMTCT programs and other health services especially maternal health care, STI prevention and early childhood immunisation. Positive and negative impact of PMTCT on other health care services and health systems are suggested in thirty-two studies while twenty-five papers recommend more integration and synergies. However, the empirical evidence of impact of PMTCT integration on broader health systems is scarce. Underlying health system challenges such as weak physical and human resource infrastructure and poor working conditions, as well as social and economic barriers to accessing health services, affect both PMTCT and the health services with which PMTCT interacts. Conclusions: PMTCT services increase to some extent the availability, accessibility and utilisation of antenatal care and services beyond HIV care. Vertical PMTCT programs work, when well-funded and well-managed, despite poorly functioning health systems. The beneficial synergies between PMTCT and other services are widely suggested, but there is a lack of large-scale evidence of this. [ABSTRACT FROM AUTHOR]

Background: Diarrheal diseases are a major cause of child mortality and one of the main causes of medical consultation for children in sub-Saharan countries. This paper attempts to determine the risk factors and neighborhood inequalities of diarrheal morbidity among under-5 children in selected countries in sub-Saharan Africa over the period 1990-2013. Design: Data used come from the Demographic and Health Survey (DHS) waves conducted in Burkina Faso (1992-93, 1998-99, 2003, and 2010), Mali (1995, 2001, 2016, and 2012), Nigeria (1990, 1999, 2003, 2008, and 2013), and Niger (1992, 1998, 2006, and 2012). Bivariate analysis was performed to assess the association between the dependent variable and each of the independent variables. Multilevel logistic regression modelling was used to determine the fixed and random effects of the risk factors associated with diarrheal morbidity. Results: The findings showed that the proportion of diarrheal morbidity among under-5 children varied considerably across the cohorts of birth from 10 to 35%. There were large variations in the proportion of diarrheal morbidity across countries. The proportions of diarrheal morbidity were higher in Niger compared with Burkina Faso, Mali, and Nigeria. The risk factors of diarrheal morbidity varied from one country to another, but the main factors included the child's age, size of the child at birth, the quality of the main floor material, mother's education and her occupation, type of toilet, and place of residence. The analysis shows an increasing trend of diarrheal inequalities according to DHS rounds. In Burkina Faso, the value of the intraclass correlation coefficient (ICC) was 0.04 for 1993 DHS and 0.09 in 2010 DHS; in Mali, the ICC increased from 0.04 in 1995 to 0.16 in 2012; in Nigeria, the ICC increased from 0.13 in 1990 to 0.19 in 2013; and in Niger, the ICC increased from 0.07 in 1992 to 0.11 in 2012. Conclusions: This suggests the need to fight against diarrheal diseases on both the local and community levels across villages. [ABSTRACT FROM AUTHOR]

Cervical cancer is the second most common cancer and the leading cause of cancer-related death in women in sub-Saharan Africa. It is estimated that more than 200 million females older than 15 years are at risk in this region. This paper highlights the current burden of cervical cancer in sub-Saharan Africa, reviews the latest clinical data on primary prevention, outlines challenges in the region, and offers potential solutions to these barriers. Based on these factors, clinical recommendations for the prevention of cervical cancer from the sub-Saharan African Cervical Cancer Working Group expert panel are presented. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) revised its global recommendations on treating pregnant women infected with the human immunodeficiency virus (HIV) with antiretrovirals and preventing mother-to-child transmission (PMTCT) of HIV. Initial draft recommendations issued in November 2009 were followed by a full revised guideline in July 2010. The 2010 recommendations on PMTCT have important implications in terms of planning, human capacity and resources. Ministries of health therefore had to adapt their national guidelines to reflect the 2010 PMTCT recommendations, and the Elizabeth Glaser Pediatric AIDS Foundation tracked the adaptation process in the 14 countries where it provides technical support. In doing so it sought to understand common issues, challenges, and the decisions reached and to properly target its technical assistance. In 2010, countries revised their national guidelines in accordance with WHO's most recent PMTCT recommendations faster than in 2006; all 14 countries included in this analysis formally conducted the revision within 15 months of the 2010 PMTCT recommendations' release. Governments used various processes and fora to make decisions throughout the adaptation process; they considered factors such as feasibility, health delivery infrastructure, compatibility with 2006 WHO guidelines, equity and cost. Challenges arose; in some cases the new recommendations were implemented before being formally adapted into national guidelines and no direct guidance was available in various technical areas. As future PMTCT guidelines are developed, WHO, implementing partners and other stakeholders can use the information in this paper to plan their support to ministries of health. INSET: Box 1. Summary of key changes in the 2010 PMTCT.... [ABSTRACT FROM AUTHOR]

Partnerships between civil society groups campaigning for reproductive and human rights, health professionals and others could contribute more to the strengthening of health systems needed to bring about declines in maternal deaths in Africa. The success of the HIV treatment literacy model developed by the Treatment Action Campaign in South Africa provides useful lessons for activism on maternal mortality, especially the combination of a right-to-health approach with learning and capacity building, community networking, popular mobilisation and legal action. This paper provides examples of these from South Africa, Botswana, Kenya and Uganda. Confidential enquiries into maternal deaths can be powerful instruments for change if pressure to act on their recommendations is brought to bear. Shadow reports presented during UN human rights country assessments can be used in a similar way. Public protests and demonstrations over avoidable deaths have succeeded in drawing attention to under-resourced services, shortages of supplies, including blood for transfusion, poor morale among staff, and lack of training and supervision. Activists could play a bigger role in holding health services, governments, and policy-makers accountable for poor maternity services, developing user-friendly information materials for women and their families, and motivating appropriate human resources strategies. Training and support for patients' groups, in how to use health facility complaints procedures is also a valuable strategy. Les partenariats entre les groupes de la société civile qui militent pour les droits de l'homme et les droits génésiques, les professionnels de la santé et d'autres pourraient contribuer davantage au renforcement des systèmes de santé requis pour réduire les décès maternels en Afrique. Le succès du modèle de connaissances de base sur le traitement du VIH mis au point par la Treatment Action Campaign en Afrique du Sud donne de précieuses leçons à ceux qui luttent contre la mortalité maternelle, en particulier l'association d'une approche du droit à la santé avec l'éducation et le renforcement des capacités, la création de réseaux communautaires, la mobilisation populaire et les mesures juridiques. L'article décrit certaines de ces activités en Afrique du Sud, au Botswana, au Kenya et en Ouganda. Des enquêtes confidentielles sur les décès maternels peuvent être des outils puissants pour le changement, si des pressions sont exercées pour donner suite à leurs recommandations. On peut utiliser de la même manière les rapports parallèles présentés aux organes des droits de l'homme des Nations Unies pendant les évaluations des pays. Les manifestations publiques pour protester contre des décès évitables ont réussi à mettre en lumière le manque de ressources des services, la pénurie de fournitures, y compris de sang pour les transfusions, la démoralisation du personnel, et le manque de formation et de supervision. Les militants pourraient jouer un rôle plus actif pour rendre les services de santé, les gouvernements et les décideurs comptables de la mauvaise qualité des services de maternité, préparer du matériel informatif adapté aux femmes et aux familles, et prôner des stratégies appropriées de ressources humaines. Il serait aussi utile de former les groupes de patientes et de les aider à utiliser les procédures de plainte contre les centres de santé. Las alianzas entre grupos de la sociedad civil que abogan por los derechos reproductivos yhumanos, profesionales de la saludy otras personas podrían contribuir más a fortalecer los sistemas de salud necesarios para lograr disminuir las tasas de mortalidad materna en Ãfrica. El éxito del modelo de educación sobre el tratamiento del VIH, creado por la Campaña de Acción para el Tratamientoen Sudáfrica,ofrece lecciones útiles para el activismo relacionado con la mortalidad materna, especialmente la combinación de un enfoque de derecho a la saludcon el desarrollo de conocimientos y capacidad, la creación de redes de contactos comunitarios, movilización popular y acción jurídica. En este artículo se exponen ejemplos de estas lecciones en Sudáfrica, Botsuana, Kenia y Uganda. Las investigaciones confidenciales de muertes maternas pueden ser poderosos instrumentos para realizar cambios si se ejerce presión para que se sigan sus recomendaciones. Los informes sombra presentados durante las evaluaciones realizadas por las Naciones Unidasde los derechos humanosen esos países se pueden utilizar de manera similar. Las protestas y manifestaciones públicas respecto a muertes evitables han logrado llamar la atención a servicios con escasos recursos, escasez de insumos como sangre para transfusiones, moral bajaentre el personaly falta de capacitación y supervisión. Los activistas podrían desempeñar un mayor papel en imputara los servicios de salud, gobiernos y formuladores de políticasla responsabilidad de los deficientes servicios de maternidad, elaborar materiales informativos fáciles de utilizar para las mujeres y familias, y motivarestrategias con recursos humanos correspondientes. Otra estrategia valiosa es capacitar y apoyar a los grupos de pacientes en el uso de los procedimientos para presentar querellas en las unidades de salud. [ABSTRACT FROM AUTHOR]

Study design:Review.Objectives:The aim is to highlight the epidemiology of spinal cord injuries (SCIs) in Sub-Saharan Africa in order to improve prevention strategies.Setting:University Hospitals Leuven, Belgium.Methods:Pubmed was searched over August and September 2010. A combination of the following MeSH-terms was used: 'Africa South of the Sahara', 'Spinal Cord Diseases', 'Paraplegia' and 'Spinal Cord Injuries'. Limits were set on articles published as from 1990. The World Health Organization database was also consulted.Results:We obtained 243 hits of which 13 articles were relevant to the case. These papers covered seven countries: Ethiopia, Ghana, Nigeria, Senegal, Sierra Leone, South Africa and Zimbabwe. In traumatic SCIs, motor vehicle accidents are the most frequent cause of injury followed by falling from a height and thirdly violence, being the most important cause of SCI in South Africa. In the Plateau State of Nigeria, collapsing tunnels in illegal mining are the most prevalent cause. For the non-traumatic SCIs, tuberculosis appeared to be the most important cause, followed by malignant illnesses. Human immunodeficiency virus (HIV) serology tests were only available in the article concerning Ethiopia. Relatively more men were involved in traumatic SCIs and the average age was higher in the non-traumatic than in the traumatic group.Conclusion:Although literature on the subject is scarce, prevention should focus on road-safety, tuberculosis and HIV. Standardized registration of SCI is needed for prevention and further research. The use of the current International SCI core data set should be encouraged worldwide as a uniform classification method. [ABSTRACT FROM AUTHOR]

Background: The rise of non-communicable diseases (NCDs) in Africa requires a multi-sectoral action (MSA) in their prevention and control. This study aimed to generate evidence on the extent of MSA application in NCD prevention policy development in five sub-Saharan African countries (Kenya, South Africa, Cameroon, Nigeria and Malawi) focusing on policies around the major NCD risk factors.Methods: The broader study applied a multiple case study design to capture rich descriptions of policy contents, processes and actors as well as contextual factors related to the policies around the major NCD risk factors at single- and multi-country levels. Data were collected through document reviews and key informant interviews with decision-makers and implementers in various sectors. Further consultations were conducted with NCD experts on MSA application in NCD prevention policies in the region. For this paper, we report on how MSA was applied in the policy process.Results: The findings revealed some degree of application of MSA in NCD prevention policy development in these countries. However, the level of sector engagement varies across different NCD policies, from passive participation to active engagement, and by country. There was higher engagement of sectors in developing tobacco policies across the countries, followed by alcohol policies. Multi-sectoral action for tobacco and to some extent, alcohol, was enabled through established structures at national levels including inter-ministerial and parliamentary committees. More often coordination was enabled through expert or technical working groups driven by the health sectors. The main barriers to multi-sectoral action included lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity and inadequate resources.Conclusion: MSA is possible in NCD prevention policy development in African countries. However, the findings illustrate various challenges in bringing sectors together to develop policies to address the increasing NCD burden in the region. Stronger coordination mechanisms with clear guidelines for sector engagement are required for effective MSA in NCD prevention. Such a mechanisms should include approaches for capacity building and resource generation to enable multi-sectoral action in NCD policy formulation, implementation and monitoring of outcomes. [ABSTRACT FROM AUTHOR]

Despite the enormous victory that has been recorded in decreasing significantly HIV-TB related mortality and morbidity in Sub-Saharan Africa, enormous challenges continue to obstruct proper and enviable control of these conditions. These range from prioritization, ethics, funding, drug resistance and research gaps. Resistance to these diseases could constitute key treatment and prevention challenges to health care systems and the international community if not handled appropriately and promptly. This paper presents key shortcomings of the current funding, management and research policies and highlights possible action areas to remedy this situation. [ABSTRACT FROM AUTHOR]