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Item Implications of WHO COVID-19 interim guideline 2020.5 on the comprehensive care for infected persons in Africa Before, during and after clinical management of cases(Elsevier B.V., 2022) Fagbamigbe, A. F.; Tolba, M. F.; Amankwaa, E. F.; Mante, P. K.; Sylverken, A. A.; Zahouli, J. Z. B.; Goonoo, N.; Mosi, L.; Oyebola, K.; Matoke-Muhia, D.; de Souza, D. K.; Badua, K.; Dukhi, N.The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa’s outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.Item How soon does modern contraceptive use starts after sexual debut in Africa? Survival analysis of timing and associated factors among never-in-union women(Elsevier B.V., 2021) Fagbamigbe, A. F.While studies abound on the utilization of modern contraceptive (MC), the timing of its uptake after sexual debut has not been given fair attention in the literature. This study estimated the time to MC uptake after sexual debut and identified the factors associated with the timings among the ever-had sex never-in-union (EHS-NIU) women in Mozambique, Nigeria and Cote d’Ivoire and adopted the health belief model. This was a cross sectional study using the Mozambique, 2011, Nigeria, 2013 and Cote d’Ivoire, 2014 DHS data. The analysis was limited to 8,251 EHS-NIU women: Mozambique (1800), Nigeria (4082) and Cote d’Ivoire (2369). Descriptive statistics, survival analysis, log-rank tests, and multivariable Cox proportional hazard regression were used at p = 0.05. Over a third (38%) of the EHS-NIU women had ever used MC: Mozambique (26%), Nigeria (47%) and Cote d’Ivoire (32%). While the median time to first MC use was 2 years across the countries, the overall median survival time was 11 years: Nigeria (7 years), Cote d’Ivoire (17 years) and Mozambique (18 years). The hazard of MC was 92% (Hazard Ratio (HR)=1.92, 95% Confidence Interval (CI): 1.74–2.12) higher among EHS-NIU women in Nigerian compared to those in Cote d’Ivoire. Compared with the EHS-NIU women aged 15–19 years, the hazard of MC uptake was 71% lower in Nigeria (adjusted Hazard Ratio (aHR)=0.29, 95% CI: 0.52–0.65), 43% lower in Mozambique (aHR=0.57, 95% CI: 050–0.67) and 49% lower in Cote d’Ivoire (aHR=0.51, 95% CI: 040–0.65) among those aged 20–24 years. EHS-NIU women with higher education, who lives in urban areas, who delayed sexual debut, who frequently listened to the radio, in richest wealth quintiles had earlier uptake of MC. There were low lifetime prevalence and late uptake of MC among ever-had sex never-in-union women in Mozambique, Nigeria, and Cote d’Ivoire. The timing of MC uptake was associated with respondents’ age, age at sexual debut, place of residence, educational attainment, wealth quintile, number of children ever born, radio listening frequency and regions of residence.Item Survival analysis and prognostic factors associated with the timing of first forced sexual act among women in Kenya, Zimbabwe and Cote d‘Ivoire(Elsevier B.V, 2019) Fagbamigbe, A. F.; Abi, R.; Akinwumi, T.; Ogunsuji, O.; Odigwe, A.; Olowolafe, T.The paucity of information on the age at which Forced Sexual Act (FSA) among women occur and the factors affecting the timings in Africa necessitated this study. We assessed the timing of first FSA and its prognostic factors among women in three African countries. We used sexual violence data of 18,528 women aged 15–49 years who participated in Zimbabwe (2011), Kenya (2014), and Cote d’Ivoire (2014) demographic and health surveys. The time of first FSA was censored as the current age of women who had not experienced FSA. Kaplan-Meier methods and Cox proportional hazard model were used at p = 0.05. The proportion who had ever experienced FSA was 13.9%, 21.7% & 27.2% while median time to FSA was 17, 20 & 18 years in Kenya, Zimbabwe, and Cote d’Ivoire respectively. The highest (41.8%) lifetime prevalence of forced sexual act was among divorced/separated women in Cote D’Ivoire. Women aged 15–19 years had earlier risk of FSA: Kenya (aHR = 3.60 (95% CI:2.43–5.34)), Zimbabwe (aHR = 2.91 (95% CI:2.32–3.65)), and Cote d’Ivoire (aHR = 2.72 (95% CI:2.22–3.33)) than women aged 40–49 years. Other significant prognostic factors of time of FSA are marital status, place of residence, employment status, religion, wealth index, and education. There are generational shifts in timing of first forced sexual act among women with girls born in the 1990s becoming victims at earlier ages than those born in the 1960s and 1970s. There is a need for a multi-sectoral approach to reduce the prevalence and halt the negative trend in forced sexual act in Africa.Item Regional Patterns and Association between Obesity and Hypertension in Africa evidence from the H3 Africa CHAIR Study(Wolters Kluwer Health, Inc., 2020) Akpa, O. M.; Made, F.; Ojo, A.; Ovbiagele, B.; Adu, D.; Motala, A. A.; Mayosi, B. M.; Adebamowo, S. N.; Engel, M. E.; Tayo, B.; Rotimi, C.; Salako, B.; Akinyemi, R.; Gebregziabher, M.; Sarfo, F.; Wahab, K.; Agongo, G.; Alberts, M.Abstract—Hypertension and obesity are the most important modifiable risk factors for cardiovascular diseases, but their association is not well characterized in Africa. We investigated regional patterns and association of obesity with hypertension among 30044 continental Africans. We harmonized data on hypertension (defined as previous diagnosis/ use of antihypertensive drugs or blood pressure [BP]≥140/90 mmHg/BP≥130/80 mmHg) and obesity from 30 044 individuals in the Cardiovascular H3Africa Innovation Resource across 13 African countries. We analyzed data from population-based controls and the Entire Harmonized Dataset. Age-adjusted and crude proportions of hypertension were compared regionally, across sex, and between hypertension definitions. Logit generalized estimating equation was used to determine the independent association of obesity with hypertension (P value<5%)Participants were 56% women; with mean age 48.5±12.0 years. Crude proportions of hypertension (at BP≥140/90 mmHg) were 47.9% (95% CI, 47.4–48.5) for Entire Harmonized Dataset and 42.0% (41.1–42.7) for population-based controls and were significantly higher for the 130/80 mmHg threshold at 59.3% (58.7–59.9) in population-based controls. The age-adjusted proportion of hypertension at BP≥140/90 mmHg was the highest among men (33.8% [32.1–35.6]), in western Africa (34.7% [33.3–36.2]), and in obese individuals (43.6%; 40.3–47.2). Obesity was independently associated with hypertension in population-based controls (adjusted odds ratio, 2.5 [2.3–2.7]) and odds of hypertension in obesity increased with increasing age from 2.0 (1.7–2.3) in younger age to 8.8 (7.4–10.3) in older age. Hypertension is common across multiple countries in Africa with 11.9% to 51.7% having BP≥140/90 mmHg and 39.5% to 69.4% with BP≥130/80 mmHg. Obese Africans were more than twice as likely to be hypertensive and the odds increased with increasing age. (Hypertension. 2020;75:00-00. DOI: 10.1161/HYPERTENSIONAHA.119.14147.)Item Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke(Elsevier Inc., 2017) Owolabi M.; Ogbole G.; Akinyemi R.; Salaam K.; Akpa O.; Mongkolwat P.; Omisore A.; Agunloye A.; Efidi R.; Odo J.; Makanjuola A.; Akpalu A.; Sarfo F.; Owolabi L.; Obiako R.; Wahab K.; Sanya E.; Adebayo P.; Komolafe M.; Adeoye A. M.; Fawale M. B."Background: Annotation and Image Markup on ClearCanvas Enriched Stroke– phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies. Methods: One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen’s kappa statistics. Results: For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes. Conclusion: The ACCESS application facilitates a con cordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.