Background: Intimate Partner Violence (IPV) against women is a major public health and human rights problem worldwide. Sub-Saharan Africa (SSA) has one of the highest prevalence of IPV against women in the world. This study used meta-analysis to obtain pooled rural–urban and education attainment differences in the prevalence of IPV among ever-partnered women in SSA, and assessed whether the differences in IPV depended on the SSA region or period or women’s age. Methods: We analysed IPV data on 233,585 ever-partnered women aged 15–49 years from 44 demographic and health surveys conducted between 2000 and 2018 in 29 SSA countries. Random-effects meta-analyses were used to estimate overall rural–urban residence and educational differences in IPV rates among the women in SSA. Subgroup analyses were also done to investigate the sources of heterogeneity in the overall meta-analysis findings. Results: The pooled prevalence of intimate partner violence was estimated to be 41.3% (37.4–45.2%). Regionally, the highest prevalence of IPV was in Middle Africa (49. 3%; 40.32–58.45), followed by East Africa (44.13%; 36.62–51.67), Southern Africa (39.36%; 34.23–44.49), and West Africa (34.30%; 27.38–41.22). The risks of experiencing IPV were significantly higher if the women had less than secondary education (RR = 1.12; 95% CI 1.07–1.22) compared to those with at least a secondary education. Generally, women who resided in a rural area had their risks of experiencing IPV increased (RR = 1.02; CI 0.96–1.06) compared to those who resided in urban areas, but the IPV increases were only significant in East Africa (RR = 1.13; CI 1.07–1.22). Conclusion: In sub-Saharan Africa, intimate partner violence against women is widespread, but the levels are much higher among women with lower levels of education and residing in rural areas. Our findings have provided additional support to policies aimed at achieving SDG goals on the elimination of all forms of violence against women and girls in sub-Saharan Africa. For example, policies that advocate improved educational attainment, especially among women and communities in rural areas.

The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa. This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre’s (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as “a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit”. Out of 595 patients, 65.5 % (n = 390) were female and 23.4 % (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 – 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95 % CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98 - 6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38 - 0.99, p = 0.044) of becoming LTFU than those that had not. The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.

To compare the discriminative performance of the PURSUIT, GUSTO-1, GRACE, SRI and EMMACE risk models, assess their performance among risk supergroups and evaluate the EMMACE risk model over the wider spectrum of acute coronary syndrome (ACS). Design: Observational study of a national registry. Setting: All acute hospitals in England and Wales. Patients: 100 686 cases of ACS between 2003 and 2005. Main outcome measures: Model performance (C-index) in predicting the likelihood of death over the time period for which they were designed. The C-index, or area under the receiver-operating curve, range 0–1, is a measure of the discriminative performance of a model. Results: The C-indexes were: PURSUIT C-index 0.79 (95% confidence interval 0.78 to 0.80); GUSTO-1 0.80 (0.79 to 0.81); GRACE in-hospital 0.80 (0.80 to 0.81); GRACE 6-month 0.80 (0.79 to 0.80); SRI 0.79 (0.78 to 0.80); and EMMACE 0.78 (0.77 to 0.78). EMMACE maintained its ability to discriminate 30-day mortality throughout different ACS diagnoses. Recalibration of the model offered no notable improvement in performance over the original risk equation. For all models the discriminative performance was reduced in patients with diabetes, chronic renal failure or angina. Conclusion: The five ACS risk models maintained their discriminative performance in a large unselected English and Welsh ACS population, but performed less well in higher-risk supergroups. Simpler risk models had comparable performance to more complex risk models. The EMMACE risk score performed well across the wider spectrum of ACS diagnoses.

Objective:In sub-Saharan Africa, large proportions of patients who are on antiretroviral therapy (ART) engage in excessive alcohol use, which may lead to adverse health consequences and may go undetected. Consequently, health care workers need brief screening tools to be able to routinely identify and manage excessive alcohol use among their patients. Various brief versions of the valid and reliable 10-item Alcohol Use Disorders Identification Test (AUDIT) (i.e., the AUDIT-C, AUDIT-3, AUDIT-QF, AUDIT-PC, AUDIT-4, and m-FAST) may potentially replace the full AUDIT in busy HIV care settings. This study aims to assess the utility of these six brief versions of the AUDIT relative to the full AUDIT for identifying excessive alcohol use among patients in HIV care settings in South Africa.Method:Participants were 188 (95 women) patients from three ART clinics within district hospitals in the City of Tshwane Metropolitan Municipality who reported past-12-month alcohol use. Performance of each brief AUDIT measure ...

Background: Diabetes prevalence, as well as that of pre-diabetes, is rapidly increasing in South Africa. Individuals with pre-diabetes have a high risk of developing type 2 diabetes, which is reversible with a change in lifestyle. If left untreated, diabetes can lead to serious health complications. Our objective was to assess the prevalence of diabetes and pre-diabetes, and to investigate the associated risk factors of each in the South African population. Method: This study made use of the South African Demographic Health Survey 2016 data. The study participants included 6442 individuals aged 15 years and older. A generalized additive mixed model was employed to account for the complex survey design of the study as well as well spatial autocorrelation in the data. Results: The observed prevalence of pre-diabetes and diabetes was 67% and 22%, respectively. Among those who had never been tested for diabetes prior to the survey, 10% of females and 6% of males were found to be diabetic, and 67% of both males and females were found to be pre-diabetic. Thus, a large proportion of the South African population remains undiagnosed. The model revealed both common and uncommon factors significantly associated with pre-diabetes and diabetes. This highlights the importance of considering diabetic status as a three-level categorical outcome, rather than binary. In addition, significant interactions between some of the lifestyle factors, demographic factors and anthropometric measures were revealed, which indicates that the effects each these factors have on the likelihood of an individual being pre-diabetic or diabetic is confounded by other factors. Conclusion: The risk factors for diabetes and pre-diabetes are many and complicated. Individuals need to be aware of their diabetic status before health complications arise. It is therefore important for all stakeholders in government and the private sector of South Africa to get involved in providing education and creating awareness about diabetes. Regular testing of diabetes, as well as leading a healthy lifestyle, should be encouraged.

Computer-aided detection (CAD) can help identify people with active tuberculosis left undetected. However, few studies have compared the performance of commercially available CAD products for screening in high tuberculosis and high HIV settings, and there is poor understanding of threshold selection across products in different populations. We aimed to compare CAD products' performance, with further analyses on subgroup performance and threshold selection. We evaluated 12 CAD products on a case–control sample of participants from a South African tuberculosis prevalence survey. Only those with microbiological test results were eligible. The primary outcome was comparing products' accuracy using the area under the receiver operating characteristic curve (AUC) against microbiological evidence. Threshold analyses were performed based on pre-defined criteria and across all thresholds. We conducted subgroup analyses including age, gender, HIV status, previous tuberculosis history, symptoms presence, and current smoking status. Of the 774 people included, 516 were bacteriologically negative and 258 were bacteriologically positive. Diverse accuracy was noted: Lunit and Nexus had AUCs near 0·9, followed by qXR, JF CXR-2, InferRead, Xvision, and ChestEye (AUCs 0·8–0·9). XrayAME, RADIFY, and TiSepX-TB had AUC under 0·8. Thresholds varied notably across these products and different versions of the same products. Certain products (Lunit, Nexus, JF CXR-2, and qXR) maintained high sensitivity (>90%) across a wide threshold range while reducing the number of individuals requiring confirmatory diagnostic testing. All products generally performed worst in older individuals, people with previous tuberculosis, and people with HIV. Variations in thresholds, sensitivity, and specificity existed across groups and settings. Several previously unevaluated products performed similarly to those evaluated by WHO. Thresholds differed across products and demographic subgroups. The rapid emergence of products and versions necessitates a global strategy to validate new versions and software to support CAD product and threshold selections. Government of Canada.