Shamsudeen Mohammed

Breast cancer and its treatments impact on women's health‐related quality of life, but few studies have assessed these outcomes among survivors in sub‐Saharan Africa (SSA). We investigated longitudinal changes in Global Health Status (GHS) and their correlates within the African Breast Cancer‐Disparities in Outcomes cohort. Newly diagnosed women (≥18 years) across five SSA countries were recruited in 2014–2017. In four countries, follow‐up interviews were conducted 3‐monthly over 7 years using the European Organisation for Research and Treatment of Cancer Quality of Life 30‐item core questionnaire version 3. Multilevel mixed‐effects models identified correlates of GHS. Overall, 1358 women from Namibia, Nigeria, Uganda and Zambia were included, with a mean age of 50.6 (SD = 13.7) years. Median follow‐up time was 3 (IQR = 2–5) years, with a median of 18 GHS assessments per woman (IQR = 10–23). GHS was lowest in the first 6 months post‐diagnosis but improved gradually thereafter. GHS increased with increasing education ( p ‐value for linear trend [ p _t ] < .0001), breast cancer awareness (adjusted‐odds ratio: 1.32; 95% confidence interval 1.22–1.42), surgical treatment (1.90; 1.53–2.37), family support (1.46; 1.24–1.71) and maintaining pre‐diagnosis employment (1.54; 1.41–1.68). In contrast, GHS decreased with increasing age at diagnosis ( p _t <.0001), rural residence (0.76; 0.70–0.82), advanced tumour stage at diagnosis ( p _t <.0001) and having non‐HIV comorbidities (0.74; 0.60–0.92). GHS was not affected by HIV status, but it was higher during COVID‐19 lockdowns than pre‐/post‐lockdown (1.27; 1.09–1.49). These patterns were similar at young and older ages, and in the short‐ and long‐term. The potentially modifiable factors associated with GHS are known to influence breast cancer survival in SSA. Addressing them could improve survivorship and survival from this cancer in the region.

Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the state of knowledge on climate-related health impacts in Kenya, a scoping review of 25 years of environmental health research was conducted. In compliance with a pre-registered protocol, nine bibliographic databases and grey literature sources were searched for articles published from 2000 to 2024. Of 19,234 articles screened, 816 full texts were reviewed in duplicate, and a final 348 articles underwent data extraction for topic categorisation, trend analysis, and narrative summary. Most of the studies (97%, n = 336) were journal articles, with 64% published after 2014 (n = 224). The health topics centred on vector-borne diseases (45%, n = 165), primarily vector abundance (n = 111) and malaria (n = 67), while mental health (n = 12) and heat exposure (n = 9) studies were less frequent. The research was geographically concentrated on the Lake Victoria Basin, Rift Valley, and Coastal regions, with fewer studies from the northern arid and semi-arid regions. The findings show a shift from a focus on infectious diseases towards broader non-communicable outcomes, as well as regional disparities in research coverage. This review highlights the development of baseline associations between environmental exposures and health outcomes in Kenya, providing a necessary foundation for evidence-informed climate change and health policy. However, challenges in data and study designs limit some of the evidentiary value.

Intimate partner violence (IPV) during pregnancy increases the risk of adverse outcomes for both the woman and foetus. However, there is limited research on its scope and impact in many sub-Saharan African countries. In this study, we investigated the effects of IPV during pregnancy on pregnancy and childbirth complications in Ethiopia. Prospective, longitudinal data from the Performance Monitoring for Action Ethiopia (PMA Ethiopia) Cohort 1 study covering a sample of 2635 women followed up until one year postpartum was used for analysis. Information on IPV during pregnancy and obstetric complications were collected from women at six-week follow-up visits. Multivariable log-binomial regression estimated the risk of antepartum, intrapartum, and postpartum complications associated with IPV of any type, physical IPV and sexual IPV during pregnancy. The prevalence of any IPV type was 13%, only physical IPV was 4.6%, and only sexual IPV was 7.1%. Physical IPV was associated with an increased risk of worsening vision at night during pregnancy (adjusted relative risk [aRR]=2.47, 95% Confidence Interval [95%CI]=1.46 - 4.77), intrapartum haemorrhage (aRR=1.65, 95%CI=1.11 - 2.46), and intrapartum convulsion (aRR=1.98, 95%CI=1.34 - 2.94). Sexual IPV was associated with increased risk for antepartum convulsion (aRR=1.93, 95%CI=1.07 - 3.48), leaked/ruptured membrane (aRR=2.86, 95%CI=1.59 - 5.14), malpresentation (aRR=2.37, 95%CI=1.17 - 4.80), intrapartum convulsions (aRR=1.86, 95%CI=1.16 - 2.98), postpartum haemorrhage (aRR=1.68, 95%CI=1.18 - 2.40) and fever with foul discharge (aRR=2.03, 95%CI=1.40 - 2.93). Overall, the experience of any IPV type increased the risk for the above in addition to migraine, postpartum convulsion, and abnormal vaginal discharge. There is a need to embed IPV sensitisation campaigns in maternal health policies and interventions and to empower women to report cases for timely intervention.

Background: Breastfeeding rates in sub-Saharan Africa (SSA) are declining, and at the current rate, only four African countries will meet the WHO’s 2030 exclusive breastfeeding target. We examined the association between maternal socioeconomic status (SES) and breastfeeding practices in SSA. Methods: Six cohorts in Ethiopia, Malawi, Uganda and Zambia, with 11 863 participants, were analysed. Data for the cohorts were collected between 2000 and 2021, covering births from 2000 to 2019. SES exposures were maternal education and household income. Breastfeeding outcomes included ever breastfed, early initiation of breastfeeding (Ethiopia only), exclusive breastfeeding for ≥4 months or ≥6 months, and continued breastfeeding for ≥1 year. Risk ratios from multivariable Poisson regression models for individual cohorts were pooled in a random-effects meta-analysis to assess the effects of SES on breastfeeding, adjusting for confounders. Results: Meta-analysis found no evidence of a difference in ever breastfeeding between mothers with secondary or tertiary education and those with primary/no education. Mothers with secondary education (adjusted risk ratio (aRR)=1.11, 95% CI=1.01 to 1.21) and those from middle-wealth households (aRR=1.12, 95% CI=1.01 to 1.24) were more likely to initiate breastfeeding early than those with primary/no education or low household wealth, but there was no evidence of association in the tertiary education and higher-wealth groups. The association between maternal education and exclusive breastfeeding for ≥4 months and ≥6 months varied across cohorts, with no evidence of association in most cohorts. Overall, household wealth was not associated with exclusive breastfeeding for ≥4 months or ≥6 months. The meta-analysis showed no evidence of association between household wealth and breastfeeding for ≥1 year, but mothers with tertiary education were less likely (aRR=0.93, 95% CI=0.88 to 0.99) to breastfeed for ≥1 year than those with primary or no education. Conclusion: We observed no clear socioeconomic pattern in breastfeeding, contrasting with patterns observed in high-income countries.

Climate change threatens health and social development gains in Kenya, necessitating health policy planning for risk reduction and mitigation. To understand the baseline state of knowledge of environmental determinants of health in Kenya relevant to climate change, a comprehensive scoping review was undertaken. Compliant with a pre-registered protocol, nine bibliographic databases and grey literature sources were searched for articles published from 2000-2023. Two-stage screening was conducted on 17,394 articles; 635 full-texts were screened in duplicate. A final 353 articles underwent data extraction for topic categorisation, bibliometric analysis, and narrative summary. This was comprised of 344 (97%) journal articles, 59% of which were published after 2014 (n=207). Main study designs included observational (n=211) and modelling studies (n=64). Health topics centred on vector-borne diseases (41%, n=147), primarily vector abundance (n=102) and malaria (n=60), while injury or death (n=10), mental health conditions (n=7) and heat exposure (n=7) studies were less frequent. Environmental health research in Kenya is largely conducted in the Lake Victoria Basin, Rift Valley and Coastal regions, with fewer studies from the northern arid and semi-arid regions. Findings of this review suggest a growing and diverse field of predominantly observational research with an increasing focus on social determinants and policy-relevant themes, however research on vector-borne disease dwarfs other health outcomes and sparsely populated but climatically fragile regions are less represented in published literature. Addressing existing gaps in baseline evidence underpinning associations between the environment and health outcomes will benefit climate change attribution research and support future development of evidence-informed climate change and health policy in Kenya.

Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. This study investigated the association between breastfeeding duration and children’s educational attainment in rural Southwest Uganda. We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. Most mothers breastfed for more than a year. Just over one-third breastfed for 18–23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7–12, 13–17, 18–23, and > 23 months compared to those breastfed for 0–6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children’s health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.

The benefits of exclusive breastfeeding (EBF) for infant health and survival are well documented. However, its impact on educational outcomes has been contested and poorly researched in Africa. It has been hypothesised that positive associations reported in high-income countries can be attributed to residual confounding by socioeconomic status (SES). Our study investigated whether EBF duration in infancy is associated with educational attainment and age-for-grade attainment trajectories at school-age in rural Malawi. Longitudinal data on 1021 children at the Karonga demographic surveillance site in Malawi were analysed. Breastfeeding data were collected 3 months after birth and again at age one. The school grade of each child was recorded each year from age 6 until age 13. We calculated age-for-grade based on whether a child was at, over, or under the official expected age for a grade. Generalised estimating equations estimated the average effect of breastfeeding on age-for-grade. Latent class growth analysis identified age-for-grade trajectories, and multinomial logistic regression examined their associations with EBF. Maternal-child characteristics, SES, and HIV status were controlled. Overall, 35.9% of the children were exclusively breastfed for 6 months. Over-age for grade steadily increased from 9.6% at age 8 to 41.9% at age 13. There was some evidence that EBF for 6 months was associated with lower odds of being over-age for grade than EBF for less than 3 months (aOR = 0.82, 95%CI = 0.64–1.06). In subgroup analyses, children exclusively breastfed for 6 months in infancy were less likely to be over-age for grades between ages 6–9 (aOR = 0.64, 95%CI = 0.43–0.94). Latent class growth analysis also provided some evidence that EBF reduced the odds of falling behind in the early school grades (aOR = 0.66, 95%CI = 0.41–1.08) but not later. Our study adds to the growing evidence that EBF for 6 months has benefits beyond infant health and survival, supporting the WHO's recommendation on EBF.

Objective Understanding the determinants of adolescent pregnancy and how they have changed over time is essential for measuring progress and developing strategies to improve adolescent reproductive health. This study examined changes over time in the prevalence and determinants of adolescent pregnancy in Ghana. Methods A total of 11 nationally representative surveys from the Ghana Demographic and Health Survey (1988, 1993, 1998, 2003, 2008, 2014), Multiple Indicator Cluster Survey (2006, 2011, 2017–2018) and Malaria Indicator Survey (2016 and 2019) provided data on 14 556 adolescent girls aged 15–19 for this analysis. A random-effect meta-analysis, time trends and multivariable logistic regression models were used to track the prevalence and determinants of adolescent pregnancy. Results The pooled prevalence of adolescent pregnancy in Ghana was 15.4% (95% CI=13.49% to 17.30%). Rural areas (19.5%) had a higher prevalence of adolescent pregnancy than urban areas (10.6%). In the overall sample, middle adolescents (15–17 years) (aOR=0.30, 95% CI=0.23 to 0.39), adolescents in urban areas (aOR=0.56, 95% CI=0.43 to 0.74), large households (aOR=0.62, 95% CI=0.49 to 0.78), not working (aOR=0.62, 95% CI=0.43 to 0.90) and those unaware of contraceptive methods (aOR=0.49, 95% CI=0.27 to 0.90) were less likely to become pregnant. Adolescents from middle-income (aOR=0.91, 95% CI=0.67 to 1.24) or high-income (aOR=0.59, 95%CI=0.36 to 0.94) households, those who were semiliterate (aOR=0.56, 95%CI=0.39 to 0.82) or literate (aOR=0.28, 95%CI=0.21 to 0.37) and those with fewer previous sex partners were less likely to become pregnant. Not all determinants in the overall sample were consistently associated with adolescent pregnancy in the last three decades. Between 1988 and 1998, determinants of adolescent pregnancy were age, literacy, employment, household size and whether the mother was alive. Between 2003 and 2008, age, literacy, household size, income, age of last sexual partner, number of previous partners and contraception knowledge determined adolescent pregnancy. From 2011 to 2019, age, residence, literacy and menstrual cycle knowledge were determinants of adolescent pregnancy. Conclusion Interventions and policies to prevent adolescent pregnancy should prioritise adolescents from disadvantaged backgrounds.

Background: An obstetric fistula is an inappropriate connection between the vagina, rectum, or bladder that results in faecal or urine incontinence. Young women from rural areas with poor socioeconomic situations and education are the majority of victims, which restricts their access to high-quality healthcare. Obstetric fistulas can have devastating effects on the physical health of affected women if they are not promptly treated. Inadequate awareness of the symptoms delays recognition of the problem, prompt reporting, and treatment. Women with poor awareness of the disorder are also more likely to develop complications, including mental health issues. Using data from a nationally representative survey, this study investigated the prevalence and factors associated with the awareness of obstetric fistula among women of reproductive age in The Gambia.Methods: This study used population-based cross-sectional data from the 2019–2020 Gambia Demographic and Health survey. A total of 11823 reproductive-aged women were sampled for this study. Stata software version 16.0 was used for all statistical analyses. Obstetric fistula awareness was the outcome variable. Multilevel logistic regression models were fitted, and the results were presented as adjusted odds ratios (aOR) with statistical significance set atp < 0.05.Results: The prevalence of obstetric fistula awareness was 12.81% (95%CI: 11.69, 14.12). Women aged 45–49 years (aOR = 2.17, 95%CI [1.54, 3.06]), married women (aOR = 1.39, 95%CI [1.04, 1.87]), those with higher education (aOR = 2.80, 95%CI [2.08, 3.79]), and women who worked as professionals or occupied managerial positions (aOR = 2.32, 95%CI [1.74, 3.10]) had higher odds of obstetric fistula awareness. Women who had ever terminated pregnancy (aOR = 1.224, 95%CI [1.06, 1.42]), those who listened to radio at least once a week (aOR = 1.20, 95%CI [1.02, 1.41]), ownership of a mobile phone (aOR = 1.20, 95%CI [1.01, 1.42]) and those who were within the richest wealth index (aOR = 1.39, 95%CI [1.03, 1.86]) had higher odds of obstetric fistula awareness.Conclusion: Our findings have revealed inadequate awareness of obstetric fistula among women of reproductive-age in The Gambia. Obstetric fistulas can be mitigated by implementing well-planned public awareness initiatives at the institutional and community levels. We, therefore, recommend reproductive health education on obstetric fistula beyond the hospital setting to raise reproductive-age women's awareness.

In 1929, Hoefer and Hardy reported a link between breastfeeding and cognitive development in their study of 7- to 13-year-olds in the United States [1], triggering a wave of studies investigating the association further. Since then, a number of systematic reviews and meta-analyses have evaluated and summarised the available evidence on the topic, with most […]