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In Africa, refusal of COVID-19 and other vaccines is widespread for different reasons, including disbelief in the existence of the virus itself and faith in traditional remedies. In sub-Saharan countries, refusal is often made worse by opposition to vaccines by the religious establishments. This is a pressing problem, as Africa has the highest vaccine-avoidable mortality rate for children under the age of five in the world. Dialogue between those wishing to promote vaccines and those who resist them is essential if the situation is to be improved. This article argues that Western and other aid agencies seeking to promote vaccination programs need to develop a dialogue with resisters, and in this process to embrace and commend the ancient African philosophical tradition of Ubuntu, incorporating it into these programs as a way to overcome such entrenched resistance. The paper concludes with concrete recommendations for how to accomplish this goal. [ABSTRACT FROM AUTHOR]

While several studies have examined the effect of Foreign Direct Investment (FDI) on economic development indicators, most of these studies focused on economic growth with very little attention paid to health outcomes. Moreover, among the studies that took account of health outcomes, none of them investigated the effect of FDI on child health outcomes across a sample of African countries. However, focusing on African countries is very important because sub-Saharan Africa (SSA) has the highest rate of child mortality in the world. This study, therefore, investigates the effect of FDI on child health outcomes in 39 African countries from 1980 to 2018. Neonatal and infant mortality rates are used to proxy child health outcomes. The baseline estimation technique employed is the Fixed Effects (FE) regression. However, to deal with potential endogeneity, we employ the system Generalised Method of Moments (GMM) regression as the robustness estimation technique. Our findings show that, FDI improves child health outcomes, especially through economic growth after controlling for endogeneity. Thus, in African governments' quest to reduce child mortality, a major useful strategy could be attracting more FDI inflows. [ABSTRACT FROM AUTHOR]

Africa is estimated to lose a very significant number of high‐skilled individuals through emigration. This has resulted in a number of studies investigating the effect of high‐skilled emigration on socio‐economic indicators in Africa. Notwithstanding, the majority of these studies have examined the effect of high‐skilled emigration on economic growth, with less attention paid to health outcomes. Meanwhile, health outcomes, especially child health outcomes, have major implications for future human capital and overall economic development. With sub‐Saharan Africa (SSA) having the highest child mortality rate in the world, this study, therefore, investigates the effect of the emigration of high‐skilled individuals on child health in 48 African countries for the period, 1985–2010. Neonatal mortality and infant mortality rates are used to proxy child health. The panel fixed effects and the dynamic panel system Generalised Methods of Moments (GMM) regressions are employed as estimation techniques. Using the panel fixed effects, we find that, while the emigration of high‐skilled individuals is detrimental to neonatal mortality, in the case of infant mortality, it is insignificant. However, after controlling for endogeneity using the dynamic panel system GMM, the emigration of high‐skilled individuals is found to be detrimental to both neonatal mortality and infant mortality. The results suggest that, in order to enhance child mortality in Africa, attention should be paid towards decreasing high‐skilled emigration on the continent. [ABSTRACT FROM AUTHOR]

We estimate the effect of democracy on economic growth for the countries in Sub-Saharan Africa in comparison with other countries. We find that in contrast to other countries, democracy in Africa benefits neither GDP per capita nor total GDP. We explain the former by changes in the size of the population and the latter by changes in the age structure of the population. Both demographic changes relate to the finding that unlike in other countries, democracy does not reduce child mortality in Africa. The evidence suggests that without improvements in health, democracy puts Africa on a path toward a Malthusian trap. [ABSTRACT FROM AUTHOR]

Sickle cell anemia (SCA) is the commonest life-threatening genetic disorder in tropical regions, particularly in sub-Saharan Africa. It has been estimated that between 50–90% of SCA children will die in Africa before the age of 5, corresponding to a number of 150,000–300,000 annual SCA child deaths, which represents 5–10% of total child mortality. Transfusion support remains an essential component in the management of patients with SCA and has made a significant contribution to improving patient morbidity and mortality. In Africa where the majority of patients with SCA reside, many blood transfusion challenges remains, including shortage of blood supplies, risks related to infectious and immunologic potential side effects and limitation on the diagnosis and management of post-transfusion iron overload. The proportion of transfused SCA patients varies from different studies, between 30% and 90%. This variation can be related to environmental factors, disease genetic factors and other factors including the low availability of blood, difficulties in accessing to health care and inadequacies of the transfusion system. Because blood transfusion therapy is an integral component of the management of SCA, improved efforts and strategies to overcome these challenges and optimize blood transfusion practices are needed in African countries. [ABSTRACT FROM AUTHOR]

• Clostridium difficile is more prevalent in children presenting with diarrhea than Rotavirus in Kenya. • Majority of the children with diarrhea were co-infected with C. difficile and Rotavirus. • There is a need to test for the presence of C. difficile and others in the diagnostic workup of children with diarrhea. • A comprehensive research on epidemiology of C. difficile in children with diarrhea is urgently needed. Diarrhea causes significant morbidity and mortality among children worldwide. Regions most affected by diarrhea include Sub-Saharan Africa and Southeast Asia, where antibiotics are in common use and can make children more vulnerable to Clostridium difficile and pathogens that are not affected by these drugs. Indeed, C. difficile is a major diarrhea-associated pathogen and poses a significant threat to vulnerable and immunocompromised populations. Yet, little is known about the role and epidemiology of C. difficile in diarrhea-associated illness among young children. As a result, C. difficile is often neglected in regions such as Sub-Saharan Africa that are most impacted by childhood diarrhea. The purpose of this study was to establish the frequency of C. difficile in young children (<5 years) with diarrhea. Children presenting with diarrhea at a national hospital in Kenya from 2015 to 2018 were enrolled consecutively. Following informed consent by a parent or legal guardian, stool samples were obtained from the children and demographic data were collected. The stools were examined for the presence of four common pathogens known to cause diarrhea: C. difficile , rotavirus, Cryptosporidium parvum , and Giardia lamblia. C. difficile was verified by toxigenic culture and PCR. The presence of C. parvum and/or G. lamblia was determined using the ImmunoCard STAT! Crypto/Giardia Rapid assay. Rotavirus was detected by ELISA. The study population comprised 157 children; 62.4% were male and 37.6% were female and their average age was 12.4 months. Of the 157 stool specimens investigated, 37.6% were positive for C. difficile , 33.8% for rotavirus, 5.1% for Cryptosporidium , and 5.1% for Giardia. PCR analysis identified at least one of the C. difficile -specific - genes (tcdA , tcdB , or tcdC). Further, 57.6% of the stools had C. difficile colonies bearing a frame-shift deletion in the tcdC gene, a mutation associated with increased toxin production. The frequency of C. difficile was 32.6% in children ≤12 months old and increased to 46.6% in children 12–24 months old. In Kenyan children presenting with diarrhea, C. difficile is more prevalent than rotavirus or Cryptosporidium , two leading causes of childhood diarrhea. These findings underscore the need to better understand the role of C. difficile in children with diarrhea, especially in areas with antibiotic overuse. Understanding C. difficile epidemiology and its relationship to co-infecting pathogens among African children with diarrhea will help in devising ways of reducing diarrhea-associated illness. [ABSTRACT FROM AUTHOR]

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women's education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an 'equity' approach, taking into account the specific needs of sub-populations. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether country-level urban population growth is associated with the magnitude of the urban-rural disparity in under-five mortality (U5M) using ecologic and multilevel analyses.Methods: We used data from 2010 to 2015 Demographic and Health Surveys and World Bank data from 30 sub-Saharan African countries (n = 411,054 women). Country-level linear regressions determined associations between urban population growth and economic growth between 2005 and 2010 on U5M risk differences. Multilevel logistic regression models were used to determine the impact of urban population growth on the urban advantage in U5M, adjusting for child and maternal factors.Results: Countries with greater urban population growth and low economic growth had greater disparities in U5M between urban and rural areas. After adjusting for known U5M risk factors in multilevel analyses, interactions between country-level urban population growth and urbanicity were identified.Conclusions: Continued efforts to evaluate and address disparities in child mortality outcomes in sub-Saharan Africa should acknowledge urbanicity in context, as well as socioeconomic and geographic realities of families, mothers and children. Low-resource, demographically shifting environments require novel strategies to decrease child mortality. [ABSTRACT FROM AUTHOR]

Background: Despite substantial financial contributions by the United States President's Malaria Initiative (PMI) since 2006, no studies have carefully assessed how this program may have affected important population-level health outcomes. We utilized multiple publicly available data sources to evaluate the association between introduction of PMI and child mortality rates in sub-Saharan Africa (SSA).Methods and Findings: We used difference-in-differences analyses to compare trends in the primary outcome of under-5 mortality rates and secondary outcomes reflecting population coverage of malaria interventions in 19 PMI-recipient and 13 non-recipient countries between 1995 and 2014. The analyses controlled for presence and intensity of other large funding sources, individual and household characteristics, and country and year fixed effects. PMI program implementation was associated with a significant reduction in the annual risk of under-5 child mortality (adjusted risk ratio [RR] 0.84, 95% CI 0.74-0.96). Each dollar of per-capita PMI expenditures in a country, a measure of PMI intensity, was also associated with a reduction in child mortality (RR 0.86, 95% CI 0.78-0.93). We estimated that the under-5 mortality rate in PMI countries was reduced from 28.9 to 24.3 per 1,000 person-years. Population coverage of insecticide-treated nets increased by 8.34 percentage points (95% CI 0.86-15.83) and coverage of indoor residual spraying increased by 6.63 percentage points (95% CI 0.79-12.47) after PMI implementation. Per-capita PMI spending was also associated with a modest increase in artemisinin-based combination therapy coverage (3.56 percentage point increase, 95% CI -0.07-7.19), though this association was only marginally significant (p = 0.054). Our results were robust to several sensitivity analyses. Because our study design leaves open the possibility of unmeasured confounding, we cannot definitively interpret these results as causal.Conclusions: PMI may have significantly contributed to reducing the burden of malaria in SSA and reducing the number of child deaths in the region. Introduction of PMI was associated with increased coverage of malaria prevention technologies, which are important mechanisms through which child mortality can be reduced. To our knowledge, this study is the first to assess the association between PMI and all-cause child mortality in SSA with the use of appropriate comparison groups and adjustments for regional trends in child mortality. [ABSTRACT FROM AUTHOR]

This study examined the regional differences in the role of wealth and mothers' educational attainment in explaining infant and child mortality in sub-Saharan Africa (SSA). Specifically, this study investigates the role of wealth and mothers' educational attainment in urban-rural and regional differences of SSA. We use data from Demographic and Health Surveys and the World Bank African Development Indicators to document these regional differences in infant and child mortality rates in SSA. Our findings show small variability in the risk of infant and child mortality attributable to regional differences in SSA. There is a statistically negative significant difference in infant and child mortality with urban dwellers compared to rural dwellers in SSA. Also, we found the risk of infant and child mortality to be correlated with per capita gross domestic product equal to or greater than five hundred US dollars ($500). Our findings show mother's education to be negatively correlated with infant and child mortality in SSA. These findings give credence to previous studies which highlighted the significance of wealth, education of the mother, and location in explaining infant and child mortality differences in SSA. Our study finds no evidence of a statistically significant difference in the risk of infant and child mortality between the urban poorest and poorer wealth quintile households and their rural counterparts in SSA. [ABSTRACT FROM AUTHOR]

The article discusses the decline in substantial progress in reducing child deaths which was made between 1990 and 2015 across the world and mentions how analyses will be foundational in global efforts towards Sustainable Development Goals (SDGs) for child mortality. Topics include variations to be highlighted in under-5 and neonatal mortality rates, scarcity of summary birth history data from some regions and precision public health across Africa.