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Background Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA). Methods and findings We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies. Conclusions In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management. PROSPERO number CRD42022348045., Author(s): Julia Michalow 1,*, Magdalene K. Walters 1, Olanrewaju Edun 1, Max Wybrant 1, Bethan Davies 2, Tendesayi Kufa 3, Thabitha Mathega 3, Sungai T. Chabata 4, Frances M. Cowan [...]

Objectives The aim of this paper is to share the results of a systematic review on the state of inequalities in access to and utilization of maternal, newborn and child health (MNCH) services in the sub-Saharan African region. The focus of the review was on urban settings where growing needs and challenges have been registered over the past few years due to rapid increase in urban populations and urban slums. Methods The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies published in English between 2000 and 2019 were included. A narrative synthesis of both qualitative and quantitative data was undertaken. The record for registration in PROSPERO was CRD42019122066. Results The review highlights a great variation in MNCH services utilization across urban sub-Saharan Africa (SSA). The main aspects of vulnerability to unequal and poor MNCH services utilization in urban settings of the region include poverty, low level of education, unemployment, lower socioeconomic status and poor livelihoods, younger maternal age, low social integration and social support, socio-cultural taboos, residing in slums, and being displaced, refugee, or migrant. At the health system level, persistent inequalities are associated with distance to health facility, availability of quality services and discriminating attitudes from health care personnel. Conclusion Context-specific intervention programs that aim at resolving the identified barriers to access and use MNCH services, particularly for the most vulnerable segments of urban populations, are essential to improve the overall health of the region and universal health coverage (UHC) targets., Author(s): E. M. Sidze [sup.1] , F. M. Wekesah [sup.1] , L. Kisia [sup.1] , A. Abajobir [sup.1] Author Affiliations: (1) grid.413355.5, 0000 0001 2221 4219, African Population and Health [...]

Background Pneumococcal meningitis is an infectious form of meningitis caused by the bacterium pneumococcus. Although outbreaks and clusters of invasive pneumococcal disease (such as pneumonia and bacteraemia) have been observed [...]

HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15-49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa. Fine-scale estimates of the prevalence of HIV in adults across sub-Saharan Africa reveal substantial within-country variation and local differences in both the direction and rate of change in the prevalence of HIV between 2000 and 2017., Author(s): Laura Dwyer-Lindgren [sup.1] , Michael A. Cork [sup.1] , Amber Sligar [sup.1] , Krista M. Steuben [sup.1] , Kate F. Wilson [sup.1] , Naomi R. Provost [sup.1] , Benjamin [...]

The proportion of the population that is [greater than or equal to] 60 years of age in sub-Saharan Africa (SSA) is increasing rapidly and is likely to constrain healthcare systems in the future. Nevertheless, the elderly are not a health policy priority for African countries. This paper reviews the nutritional and health status of older adults in SSA and their determinants. Literature was abstracted through the Medline, Google Scholar, and Dogpile databases using the following search terms: sub-Saharan Africa, older adults, nutrition, health. Findings showed that up to half (6-48%) of elderly Africans in SSA are underweight and almost a quarter (2.5-21%) are overweight, while 56% of older South Africans are obese. Low-quality diets contribute to poor nutritional status. Poverty, HIV/AIDS, and complex humanitarian emergencies are major determinants of undernutrition. Effective interventions need to consider socioeconomic, health, and demographic factors; social pensions may be the most cost-effective option for improving the health and nutritional status of the elderly in SSA.

This study employs a social capital perspective to examine determinants and content of informal communication about HIV/AIDS among members of different Christian congregations in Mozambique. First, we use data from a survey conducted in both rural and urban congregations to analyze factors that shape such communication, and detect that it is more likely to occur in gender-homophilous networks, in more ideologically flexible and socially diverse congregations, and in congregations located in rural areas. We then use the survey data to examine the main themes of congregation-based communication about HIV/AIDS and find denominational and location patterns that correspond to those detected in the first stage of analysis. Finally, we use qualitative data, collected in parallel with the survey, to explore how informal communication is used to reconcile the often conflicting secular and church messages. We interpret our findings in light of structural dynamics within religious congregations and the social construction of HIV/AIDS risks and prevention in that sub-Saharan setting. Keywords: religion, HIV/AIDS, Mozambique, informal communication, sub-Saharan Africa.

Keywords: inequality, power, fertility, sexuality, family Abstract We survey the literature on sub-Saharan Africa to identify how gender has factored into explaining fertility levels and behavior. Tracing the development of male role theory, we argue that despite increasing awareness of men's authority, fertility research continues to focus almost exclusively on women and treats gender as a property of individuals instead of as a system of inequality. The mainstream fertility literature generally overlooks the decision-making nexus wherein men's authority seemingly overrides women's preferences. Positing that male authority in the reproductive and sexual arenas is predicated on cultural rights negotiated at marriage-and undergirded by bridewealth payments-we contend that attempts to understand (and change) reproductive behavior will hardly be sustainable without attention to this contextual realm. In that vein, we speculate that efforts to empower women (via increased education, occupational opportunities, microcredit schemes, etc.) may hardly yield sustainable outcomes without concurrent efforts to alter cultural distributions of gendered power.

Objectives. We examined the role of community-level factors in explaining geographic variations in modern contraceptive use in 6 African countries. Methods. We analyzed Demographic and Health Survey and contextual data sources with multilevel modeling techniques to identify factors contributing to geographic variations in women's use of modern contraceptives. Results. We found significant associations between several community-level factors and reported use of modern contraceptive methods. We also identified several pathways of influence between the community and the individual. Conclusions. Aspects of a community's sociocultural and economic environment appear to influence a woman's use of modern contraceptive methods.

This paper uses Demographic and Health Surveys data from 21 countries in sub-Saharan Africa to examine the use of maternal health services by teenagers. A comparison of maternal health care between teenagers and older women, based on bivariate analysis shows little variation in maternal health care by age. However, after controlling for the effect of background factors such as parity, premarital births, educational attainment and urban/rural residence in a multivariate analysis, there is evidence that teenagers have poorer maternal health care than older women with similar background characteristics. The results from multilevel logistic models applied to pooled data across countries show that teenagers are generally more likely to receive inadequate antenatal care and have non-professional deliveries. An examination of country-level variations shows significant differences in the levels of maternal health care across countries. However, there is no evidence of significant variations across countries in the observed patterns of maternal health care by maternal age. This suggests that the observed patterns by maternal age are generalizable across the sub-Saharan Africa region. Keywords: Maternal health care; Sub-Saharan Africa; Teenagers; Multilevel models; Antenatal care; Delivery care

There is no doubt that Sub-Saharan African countries face major problems due to the HIV/AIDS pandemic that has ravaged the region. Yet the Eurocentric construction of the region as the source of the virus not only creates negative stereotypes in social science disciplines like geography, but also glosses over the potential of social science disciplines to provide knowledge and influence policy about HIV/AIDS. This oppositional construction of the region has unfortunately contributed to a glossing over of many aspects of Sub-Saharan Africa's people, their environment, culture, history, politics, economics, gender relations, and the region's global status that would provide important input for policy aimed at curbing the devastating spread of HIV in the region. This paper argues that once we recognize that HIV is a global virus with transcultural implications, social science disciplines, such as geography, can reveal certain attributes about the region and its HIV/AIDS pandemic that can be used in policy formulation to combat the spread of the virus. Keywords: Geography; HIV/AIDS; Eurocentric; Sub-Saharan Africa; Discourse; Health policy

Keywords: sexuality, health care, clinical research, pharmaceuticals, institutions Abstract It is especially the social aspects of the disease that make HIV/AIDS in sub-Saharan Africa different-and worse-than HIV/AIDS in the United States or Europe. By making Africans more vulnerable to economic and sexual exploitation, poverty first increases the likelihood that they will be infected. By making them unattractive customers for pharmaceuticals, poverty also puts therapies out of the reach of most Africans who need them. This review examines research on the integration of sub-Saharan Africa into the international worlds of the pharmaceutical trade, public health, and medical research. It finds that the pull of these institutions diminishes but does not disappear as we move from the realms of trade treaties to the clinics where testing and treatment occur and, finally, to the daily lives of people living with HIV.

Blood transfusions transmit HIV more effectively than other means, yet there has been little examination of their role in the origins and early course of AIDS in sub-Saharan Africa. We review historical data in archives, government reports, and medical literature from African and European sources documenting the introduction, establishment, use, and growth of blood transfusions in sub-Saharan Africa. These data allow estimation of the geographic diffusion and growth of blood transfusions between 1940 and 1990. By 1955,19 African colonies and countries reported transfusion programs--with national rates of 718 to 1372 per 100 000 by 1964, and urban rates similar to those in developed countries. We estimated 1 million transfusions per year in sub-Saharan Africa by 1970 and 2 million per year by the 1980s, indicating that transfusions were widely used throughout sub-Saharan Africa during the crucial period of 1950-1970, when all epidemic strains of HIV first emerged in this region. doi:10.2105/AJPH.2004.061630)

We assessed the impact of HIV-1 on malaria in the sub-Saharan African population. Relative risks for malaria in HIV-infected persons, derived from literature review, were applied to the HIV-infected population [...]

The reasons for prevalence of high rate of sexually transmitted diseases like HIV/AIDS in Sub-Saharan Africa are presented. It may be noted that of the 40 million HIV infections worldwide, twenty five million are from this region.

Articles on the impact of the AIDS epidemic on schoolchildren and teaching staff in sub-Saharan Africa are critiqued. The need for caution in interpretation of data, risks of making sweeping generalizations, and the necessity for refining the conclusions, are discussed.

This report examines the three groups of schoolchildren that are directly affected by the AIDS epidemic, namely children who are HIV positive or have AIDS, children who are orphaned by parents or guardians suffering from the disease, and children taking care of sick family members. The impact so far, of the epidemic on the schooling of these children, likely effects on them over the next 10-15 years, and the school-based support and national policies and strategies needed to reduce their education-loss, are discussed.

Focusing on the research conducted in Botswana, Malawi and Uganda - the three countries most affected by the AIDS epidemic in sub-Saharan Africa, a report is presented on the impact so far, of the epidemic on the mortality, morbidity and absenteeism of teaching staff, the impact on them over the next ten to fifteen years, and the need for ministries of education to implement AIDS in the Workplace (AIW) programs in the education sector to mitigate the adverse effects.

This cross-national study seeks to understand the lagging child mortality declines in sub-Saharan Africa by using World Bank data to investigate social and economic factors at three points in time: 1970, 1985, and 1997. Women's education, foreign debt-to-export ratio, and GNP per capita are among the strongest correlates of under five mortality over time. Cross-sectional and longitudinal results suggest that female education is the best overall predictor of child mortality. Average national income does not emerge as a strong predictor, particularly since 1985. Increasing levels of foreign debt are associated with a substantial excess mortality burden. In 1997, the effect of adult HIV prevalence on child mortality was moderate and statistically significant. The study concludes that, although future gains in social factors such as female education will likely be beneficial, without simultaneously addressing high levels of foreign debt and high HIV prevalence, it may be difficult to improve child mortality rates across sub-Saharan Africa.

Abstract Endemic and epidemic group A meningococcal meningitis remains a major cause of morbidity and mortality in sub-Saharan Africa, despite the availability of the safe and inexpensive group A meningococcal [...]

An interdisciplinary approach that incorporates biomedical data into an economic analysis provides the necessary foundation for HIV/AIDS policy in poor countries. This article examines the biomedical effects of economic conditions in Africa that contribute to high rates of HIV transmission. The results of statistical analysis show the correlation of economic and epidemiological variables (nutrition, distribution of income, and urbanisation) with rates of HIV. The economic/biomedical hypothesis implies a broad policy response for confronting HIV/AIDS in Africa and in Asia and Latin America., In sub-Saharan Africa and in much of the developing world, the mode of transmission of HIV infection is primarily through heterosexual contact. The rate of HIV transmission, however, is not [...]

CONTEXT: The high prevalence of sexually transmitted infections (STIs) and their role in HIV transmission have made integrating STI prevention and management into existing family planning and antenatal care pro [...]

CONTEXT: Rigorous evaluations are needed to assess whether adolescent sexual health interventions have an effect on young people's risk-related perceptions and behaviors. METHODS: A quasi-experimental design was used to evaluate [...]

HIV/AIDS strikes with the greatest frequency in sub-Saharan Africa, a region lacking resources to deal with this epidemic. To keep millions more people from dying, wealthy countries must provide more help. Yet deeply ingrained biases may distance the sick from those who could provide far more aid. One such prejudice is viewing disease as punishment for sin. This 'punishment theory of disease' ascribes moral blame to those who get sick or those with special relations to them. Religious versions hold that God punishes them in order to castigate, encourage virtue, warn, rehabilitate, or maintain some cosmic order. Its various religious and secular forms are untenable; they lack cogency, risk blaming people unjustly, and jeopardize compassionate care for people. These views are not only irrational but also dangerous because they influence policies and cost lives. We need to cooperate and respond as befits this global public-health disaster and not engage in the misguided and bad faith activity of dividing the world into the blameworthy and blameless. Key Words: Africa, AIDS, bioethics, blame, disease, ethics, HIV, moral responsibility, population health, poverty, punishment, religion

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic, and in this issue of the Journal, seven authors discuss the moral, social and medical implications of having 70% of those stricken living in this area. Anton A. van Niekerk considers complexities of plague in this region (poverty, denial, poor leadership, illiteracy, women's vulnerability, and disenchantment of intimacy) and the importance of finding responses that empower its people. Solomon Benatar reinforces these issues, but also discusses the role of global politics in sub-Saharan Africa, especially discrimination, imperialism and its exploitation by first world countries. Given the public health crisis, Udo Schuklenk and Richard E. Ashcroft defend compulsory licensing of essential HIV/AIDS medications on consequentialist grounds. Keymanthri Moodley discusses the importance of conducting research and the need to understand a moderate form of communitarianism, also referred to as 'ubuntu' or 'communalism', to help some Africans understand research as an altruistic endeavour. Godfrey B. Tangwa also defends traditional African values of empathy and ubuntu, discussing how they should be enlisted to fight this pandemic. Loretta M. Kopelman criticizes the tendency among those outside Africa to dismiss the HIV/AIDS pandemic, attributing one source to the ubiquitous and misguided punishment theory of disease. The authors conclude that good solutions must be cooperative ventures among countries within and outside of sub-Saharan Africa with far more support from wealthy countries. Key Words: Africa, AIDS, bioethics, disease, ethics, health care, HIV, plague, research

Sub-Saharan Africa will be the family planning frontier of the twenty-first century. Fertility levels and population growth rates are still high, and family planning programs suited to the region are still being developed. Nevertheless, by the end of the twentieth century, fertility transition was under way in Southern Africa and a few countries elsewhere. Successful regional family planning in the twenty-first century will depend upon stronger political leadership, the development of family planning programs that meet the needs of all segments of society and not only currently married women, assistance to the market, and a recognition of the central importance of hormonal methods, especially injectables. Problems include stagnation in economic growth and in child mortality decline, as well as the persistence of the AIDS epidemic. (STUDIES IN FAMILY PLANNING 2002; 33[1]: 76-86), Sub-Saharan Africa will constitute the most important family planning frontier of the twenty-first century because fertility is still high in all its subregions except Southern Africa, home to less than [...]

HIV counseling and testing of pregnant women in Sub-Saharan Africa are discussed based on a study on prevention of mother-to-child HIV-1 transmission in Tanzania. It was found that improvements in counseling are needed. The study sought to determine acceptability of HIV counseling and testing and participation in a mother-to-child HIV-1 transmission intervention study using antiretroviral therapy; and 76.4% of the women agreed to be tested, with prevalence of infection 13.7% and 68.1% returning for results. Only 16.7% of the enrolled women disclosed positive status to sexual partners. Other data are given, including pregnancy recurrence rate and the percentage not wanting to carry to term.

En depit du fait que les communautes noires en general et les femmes Noires en particulier representent un element important dans l'epidemie du sida, les chercheurEs et les concepteurEs de [...]

The purpose of this paper is to review the available literature on the intersections between HIV and violence and present an agenda for future research to guide policy and programs. This paper aims to answer four questions: (1) How does forced sex affect women's risk for HIV infection? (2) How do violence and threats of violence affect women's ability to negotiate condom use? (3) Is the risk of violence greater for women living with HIV infection than for noninfected women? (4) What are the implications of the existing evidence for the direction of future research and interventions? Together this collection of 29 studies from the US and from sub-Saharan Africa provides evidence for several different links between the epidemics of HIV and violence. However, there are a number of methodological limitations that can be overcome with future studies. First, additional prospective studies are needed to describe the ways which violence victimization may increase women's risk for HIV and how being HIV positive affects violence risk. Future studies need to describe men's perspective on both HIV risk and violence in order to develop effective interventions targeting men and women. The definitions and tools for measurement of concepts such as physical violence, forced sex, HIV risk, and serostatus disclosure need to be harmonized in the future. Finally, combining qualitative and quantitative research methods will help to describe the context and scope of the problem. The service implications of these studies are significant. HIV counseling and testing programs offer a unique opportunity to identify and assist women at risk for violence and to identify women who may be at high risk for HIV as a result of their history of assault. In addition, violence prevention programs, in settings where such programs exist, also offer opportunities to counsel women about their risks for sexually transmitted diseases and HIV. Keywords: HIV; Violence; Women; Sub-Saharan Africa; United States

Sub-Saharan Africa has more than two-thirds of the world's HIV/AIDS cases and these are concentrated more densely in an 'AIDS Belt' from southern Sudan through East Africa down to South Africa. Although the number of infections seems to have stabilised in East Africa, infection rates in southern Africa continue to soar. Over 80 per cent of the HIV/AIDS infections in sub-Saharan Africa are heterosexually transmitted and around 15 per cent of infections are caused by mother to child transmission. Increased mortality among prime age adults and infants has reduced life expectancy and altered population structure. Fertility has declined, not only through behavioural changes in response to the HIV epidemic but also due to biological changes caused by the HIV infection. The combination of increased mortality and reduced fertility will significantly slow population growth rates and may even cause population decline in the coming decades. Dependency ratios and the incidence of orphanhood are rising.

Blood infection levels of Plasmodium falciparum, an organism that causes malaria in humans, are linked to chromosome 5q31-q33. The existence of complex genetic factors that control P. falciparum blood infection levels has been demonstrated through study of an urban population in Burkina Faso. From 34 families, 153 siblings were subjected to sib-pair linkage analyses between blood infection levels and chromosome 5q31-q33. Linkage of parasitemia to D5S393 and to D5S658 was found.

To the Editor: A multinational outbreak of infection with Neisseria meningitidis serogroup W135 belonging to the sequence type (ST) 11 clonal complex started in the year 2000 among pilgrims to [...]

World Bank's report entitled 'Better Health in Africa' revealed interesting information regarding the institution's stand on the state of healthcare in countries located in the Sub-Saharan Africa. The report gives Africans and Western donors a useful guide on how to deal with the region's healthcare by citing past research. On the other hand, the report tends to be biased by praising and defending Western biomedicine and attitude towards African healthcare. It seeks to disregard external pressures, which contribute to the region's poor healthcare state, being exerted by Western countries on African countries.

The use and misuse of a broad spectrum of psychoactive substances, including heroin and cocaine, is of growing concern in many African countries. Approximately one-third of global HIV and AIDS cases are reported from Africa, but injecting drug use has not yet been documented as a causative factor. The drug supply control strategy has recorded only limited success in Africa, and the currently adopted demand reduction programs are beset with many problems. In this paper we review possible constraining and facilitating factors in the adoption of harm reduction approaches in high risk sub-Saharan African countries. We conclude that appropriate needs assessments are urgently required to establish the extent of problem drug use and of injecting. This exercise may identify clinical and psychosocial problems that could benefit from an intervention approach based on a combination of the principles of harm reduction and demand reduction.

A comparative analysis of efforts to control four major vector-borne diseases that plague agricultural development in sub-Saharan Africa - onchocerciasis (river blindness), bovine trypanosomiasis, malaria, and East Coast Fever - reveals numerous similarities in the technical reasons why control programs break down. The authors conclude that there is an urgent need to develop simpler control technologies and to pay more attention to the types of socioeconomic planning (including land-use planning) that must accompany or predate disease control efforts if they are to fulfill their full economic and social potential over time. Published by Elsevier Science Ltd.

Knowledge of explanatory models of illness can be used to conduct cross-cultural epidemiological studies which, while being culturally sensitive, are also comparable with other studies. This paper reviews studies from sub-Saharan Africa which examine beliefs relating to mental illness. There is a rich diversity of beliefs, but within this diversity are a number of shared concepts. Thus, many African cultures do distinguish between the mind and body. The mind is cited as residing in the head as well as the heart or abdominal region. Spiritual causes are frequent explanations for mental illness. Though there are some similarities with biomedical concepts of mental illness, there are also significant variations, Psychotic illness is often recognized as 'madness' though emphasis is on behavioural symptoms rather than delusions; neurotic presentations are much more varied, often somatically defined and may not be considered to be mental illnesses at all. Emic psychiatric instruments need to be developed if future cross-cultural psychiatric research is to be both comparable and culturally valid. Key words - explanatory models, cross-cultural psychiatry, sub-Saharan Africa, medical anthropology

Children of missionaries assigned to sub-Saharan Africa may not receive crucial preventive health services. Comprehensive health measures of 35 children aged 8 months to 17 years old were judged inadequate for tropical climates. The children were living in African missions, such as Zaire, Kenya, and Madagascar. Preventive education about disease control, including malaria, was lacking in two thirds of all children. Nearly all or 91% of the children had incomplete immunizations and 30 children had unidentified blood types. Knowledge about water treatment and precautions with raw vegetables were also unsatisfactory among this group. Preventive immune globulin therapy against hepatitis A was almost entirely absent. Extensive education and immunizations would achieve more disease prevention among missionary families and other long-term travelers to developing countries., ABSTRACT. Objective. To determine the prevalence of basic preventive health measures for missionary children of sub-Saharan Africa. Design. A retrospective survey of the immunization status, water and vegetable treatment, malaria prophylaxis and prevention, fluoride prophylaxis, immune globulin (human) prophylaxis, and preventive education was completed on 35 missionary children, aged 8 months to 17 years (7.3 year average), from several sub-Saharan African countries. Results. Immunizations were incomplete in 91% of the children. Preventive measures were inappropriate for water treatment in 16%, cleaning of vegetables in 35%, malaria prophylaxis and prevention in 81%, fluoride prophylaxis in 84%, and immune globulin (human) prophylaxis in 94% of veteran children. Blood type was unknown in 86% and glucose-6-phosphate dehydrogenase status was unknown in all children. Sixty seven percent of the children recently examined received no preventive education. Conclusions. Missionary children of sub-Saharan Africa are not provided necessary preventive health services. Physicians and agencies working with these children must provide appropriate preventive health guidance and services. Pediatrics 1995,95:733-737; preventive health, missionary children, Africa., ABBREVIATIONS. G-6-PD, Glucose-6-phosphate dehydrogenase; AIDS, acquired immunodeficiency syndrome; CDC, Centers for Disease Control and Prevention; OPV, oral polio vaccine; RIG, rabies immune globulin; HIV, human immunodeficiency virus. DEFINITIONS. Veteran, child [...]