HIV/AIDS among Pastoralists & Refugees in North-East Africa: A Neglected Problem

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. 

This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001-2014. 

Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. 

Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. 

This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.

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By:  Serbessa MK1, Mariam DH1, Kassa A2, Alwan F3, Kloos H4.

• 1 School of Public Health, College of Health Sciences , Addis Ababa University.
• 2 IGAD Regional HIV/AIDS Partnership Program-Programme Facilitation Office (IRAPP-PFO) , Kampala , Uganda.
• 3 Intergovernmental Authority for Development (IGAD) Secretariat , Djibouti.
• 4 Department of Epidemiology and Biostatistics , University of California , San Francisco , USA. 

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Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis

OBJECTIVES:

To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen.

METHODS:

Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five.

RESULTS:

We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%-1.9%), 1.0% (95%CI: 0.3%-1.9%) and 1.9% (95%CI: 1.4%-2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%-0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%-28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%-4.9%) in Somalia and 0.6% (95%CI: 0.4%-0.8%) in Sudan.

CONCLUSION:

National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.

Full article at: 

By:  Chaabna K1,2, Kouyoumjian SP1, Abu-Raddad LJ1,2,3.

• 1Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
• 2Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America.
• 3College of Public Health, Hamad bin Khalifa University, Doha, Qatar.

PLoS One. 2016 Feb 22;11(2):e0149966. doi: 10.1371/journal.pone.0149966. eCollection 2016.

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Estimating the Magnitude of Female Genital Mutilation/Cutting in Norway: An Extrapolation Model

Background

With emphasis on policy implications, the main objective of this study was to estimate the numbers of two main groups affected by FGM/C in Norway: 1) those already subjected to FGM/C and therefore potentially in need for health care and 2) those at risk of FGM/C and consequently the target of preventive and protective measures. Special attention has been paid to type III as it is associated with more severe complications.

Methods

Register data from Statistics Norway (SSB) was combined with population-based survey data on FGM/C in the women/girls’ countries of origin.

Results

As of January 1^st 2013, there were 44,467 first and second-generation female immigrants residing in Norway whose country of origin is one of the 29 countries where FGM/C is well documented. About 40 pct. of these women and girls are estimated to have already been subjected to FGM/C prior to immigration to Norway. Type III is estimated in around 50 pct. of those already subjected to FGM/C. Further, a total of 15,500 girls are identified as potentially at risk, out of which an approximate number of girls ranging between 3000 and 7900 are estimated to be at risk of FGM/C.

Conclusion

Reliable estimates on FGM/C are important for evidence-based policies. The study findings indicate that about 17,300 women and girls in Norway can be in need of health care, in particular the 9100 who are estimated to have type III. Preventive and protective measures are also needed to protect girls at risk (3000 to 7900) from being subjected to FGM/C. Nevertheless, as there are no appropriate tools at the moment that can single these girls out of all who are potentially at risk, all girls in the potentially at risk group (15,500) should be targeted with preventive measures.

Below:  FGM/C Percentage of girls and women already subjected to FGM/C in Norway by country of origin

Below:  Numbers of girls and women subjected to FGM/C type III by most represented countries of origin

Full article at:   http://goo.gl/QFkFuS

By:  Mai M. Ziyada, Marthe Norberg-Schulz, and R. Elise B. Johansen

Norwegian Centre for Violence and Traumatic Stress Studies, P.b. 181 Nydalen, 0409 Oslo, Norway

Samfunnsøkonomisk analyse (Formerly DAMVAD Norge AS), Olavsvei 112, 1450 Nesoddtangen, Norway

Mai M. Ziyada, Email: on.stvkn@adayiz.m.m.

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Countries with Highest Prevalence of Female Genital Mutilation, 2004-15

Via:  https://atlas.qz.com/charts/EyDmnqTtx

Female Genital Mutilation/Cutting: Risk Management and Strategies for Social Workers and Health Care Professionals

Female genital mutilation/cutting (FGM/C) is a traditional practice originating in Africa. Its worst forms cause irreparable harm to girls and women and have no medical justification. Based on a literature review of global responses to FGM/C and conversations with Australian women who migrated from FGM/C practicing countries, this paper provides some background on FGM/C and its epidemiology, outlining its prevalence, types, and health risks and complications for women and girls. It discusses risk-prevention strategies, first, for health practitioners in identifying, screening, and supporting women affected by FGM/C and, second, for welfare and social workers and health care professionals to identify, work with, and prevent girls from being cut. Consistent with international trends in addressing the risks of FGM/C, the paper suggests practice responses for coordinated responses between professionals, communities from practicing countries, and governments of different countries.

Countries grouped according to prevalence, types I, II, and III and laws against FGM/C

Categories	Prevalence of girls and women of reproductive age who report having been cut, and Type of FGC/M	Countries	Countries with laws against FGM/C
1. Very high prevalence countries, almost universal	Over 80% of girls and women of reproductive age reported having been cut, 30% Type III	Somalia (98%), Guinea (96%), Djibouti (93%), Egypt (91%). Eritrea (89%), Mali (89%), Sierra Leone (88%), Sudan (88%).	Djibouti, Egypt. Eritrea, Guinea, Somalia, Sudan.
2. Moderately high prevalence countries	Between 51% and 80% of girls and women cut, predominantly Types I and II	Gambia (76%), Burkina Faso (76%), Ethiopia (74%), Mauritania (69%), Liberia (66%).	Burkina Faso, Ethiopia, Mauritania.
3. Moderately low prevalence countries	Between 26% and 50% of girls and women cut, predominantly Types I and II	Guinea Bissau (50%), Chad (44%), Cote D’Ivoire (38%), Kenya (27%), Nigeria (27%), Senegal (26%).	Chad, Cote D’Ivoire, Kenya, Senegal, Guinea Bissau, Nigeria.
4. Low prevalence	Between 10 and 25%, predominantly Types I and II	Central African Republic (24%), Yemen (23%), United Republic of Tanzania (15%), Benin (13%).	Central African Republic, Benin, United Republic of Tanzania.
5. Very low prevalence	Below 10%	Iraq (8%), Ghana (4%), Togo (4%), Niger (2%), Cameroon (1%), Uganda (1%).	Ghana, Niger, Togo.

Notes: Data from UNICEF 2013,4 and Macfarlane and Dorkenoo.15

Abbreviation: FGM/C, female genital mutilation/cutting.

Full article at:   http://goo.gl/h2My9U

By:  Susan Costello

School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia

Correspondence: Susan Costello, School of Global, Urban and Social Studies, RMIT University, 360 Swanston Street, Melbourne 3001, VIC, Australia, Email ua.ude.timr@olletsoc.nasus

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Influence of Socioeconomic Status in the Age at the of Menarche and Duration of Menstrual Bleeding

Purpose:

The study of the relationship ,between the age at menarche and socioeconomic status in a rural area in Sudan.

Work method:

This was a cross-sectional descriptive study conducted in Altadamon and Eldubha areas in the northern state of Sudan during year 2006. It included 182 girls of age between 13 to 18 years in elementary and secondary school.

Work results:

The mean age at menarche for girls in Northern Sudan in this study was 13.93 ± 1.29 year, the mean menarcheal age in these girls are amongst the lowest values presented for African countries. The mean duration of menstrual bleeding among girls in the Northern Sudan in this study was 4.8 ± 1.22 days. We also found statistically significant differences in age at menarche between girls whose parents had a higher educational level and those with a lower educational level and also according to the economic status and size of the family.

Conclusion:

Between the girls whose parents were living together and girls whose parents separated there was a significant difference of 1.02 day.

Below:  Distribution of sample according to age of menarche

Below:  Distribution of sample according to duration of menstrual bleeding

Below:  Distribution of sample according to economic status

Below:  Correlation between age of menarche and economic status

Full article at:   http://goo.gl/ekZLus

By:   Mohammed Elshiekh1 and Ammar Mohammed Ali Mohammed2

¹Department of Physiology, Faculty of Medicine, University of Dongola, Dongola, Sudan

²Department of Anatomy, Faculty of Medicine, University of Dongola, Dongola, Sudan

Corresponding author: Ammar Mohammed Ali Mohammed, MD. Department of psysiology, Faculty of medicine, University of Dongola, Dongola, Sudan. E-mail: moc.liamtoh@2002oremama

 

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Model-Predicted Evolution of Annual HIV Incidence in Sudan If No Changes Were Made to the HIV Response, 2010–2030

Via:   http://ht.ly/V7ouT  By:  https://twitter.com/unaids

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Human Immunodeficiency Virus & Viral Hepatitis among High-Risk Groups: Understanding the Knowledge Gap in the Middle East & North Africa Region

To identify gaps in the existing knowledge on single, dual and triple infections of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in the Middle East and North Africa (MENA) region among men who have sex with men (MSMs), female sex workers (FSWs), injecting drug users (IDUs) and prisoners.

We performed an extensive literature search on articles published on the topic in the 25 countries of the MENA region. PubMed database was used as the main search engine. Case reports, case series, qualitative studies, editorials, commentaries, authors’ replies and animal studies were excluded. Original articles and reviews dealing with the prevalence of HIV, HBV and HCV and their co-infection were included. Data on population type, sample size, age and markers of infections were extracted from the relevant studies.

HIV, HBV and HCV are blood-borne viruses with similar modes of transmission. The categories of people at high risk of acquiring HIV-1, HBV and HCV commonly include: MSMs, FSW and IDUs. It is well established that HIV-positive individuals co-infected with HBV or HCV suffer from liver pathology associated with morbidity and mortality. Moreover, HIV-infected individuals do not respond well to treatment for HBV or HCV and hence are at increased risk of hepatic toxicity. Consequently, co-infection of HIV-positive individuals with HBV and/or HCV is a global health problem of significant magnitude. Our review reveals the paucity of epidemiological data for key populations in many countries of the region. Limited number of studies exists in the MENA region on the status of HIV, HBV and HCV and their co-infections among prisoners, MSMs and FSWs. Evidence support the continued increase of the HIV epidemic among MSMs. In addition to the lack of studies on MSMs and FSWs in the MENA region, our review highlights the lack of data on the practices, characteristics, or the status of HIV infection and viral hepatitis among male sex workers selling or exchanging sex for money.

The MENA countries are in urgent need of advanced research and strengthening of the data collection systems and reporting practices of these infections among key populations.

Table 1

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among prisoners from Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
Egypt	500	41.0	0.0	9.8	15.8	0.0	0.0	0.0	[14]
Iran	160	16.6	0.6	0.6	NS	0.0	NS	NS	[15]
	392a	35.9	17.0	4.5	80.5	0.8	14.5	0.8	[16]
	358b	34.7	0.0	6.1	8.1	0.0	0.0	0.0	[17]
	163	34.5	0.0	7.4	7.4	0.0	0.0	0.0	[18]
	249a	35.4	15.1	4.7	64.8	1.1	14.3	1.1	[19]
	150a	31.4	42.5	18.9	75.9	NR	NR	NR	[20]
Lebanon	580	31.7	0.2	2.4	3.4	0.0	0.0	0.0	[21]
Libya	6371	> 16	18.2	6.9	23.7	NR	NR	1.5	[22]

aAmong prisoners who inject drugs;

bDrug-related convictions; n: Sample size; NR: Not reported; NS: Not studied. All numbers were rounded to the nearest 1. HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among female sex workers and men who have sex with men in Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
FSWs
Lebanon	103a	≥ 18	0.0	0.0	0.0	0.0	0.0	0.0	[23]
Libya	69a	≥ 15	10.1	2.9	7.2	0.0	4.3	0.0	[24]
Turkey	130	38.9	0.0	3.1	0.8	0.0	0.0	0.0	[25]
MSM
Lebanon	101a	≥ 18	1.0	1.0	0.0	0.0	0.0	0.0	[23]
Libya	227a	≥ 15	5.3	3.1	8.4	0.0	4.4	0.0	[24]

aNon-adjusted prevalence using respondent-driven sampling method. All numbers were rounded to the nearest 1. HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 3

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among injecting drug users in Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
Cyprus	40	25-31	0.0	0.0	50.0	0.0	0.0	0.0	[27]
Iran	202	-	NR	NS	52.0	NS	9.4	NS	[28]
	417	≥ 17	24.4	NS	80.0	NS	24.0	NS	[29]
	258	28.8	18.8	NS	65.9	NS	NR	NS	[30]
	233	32.3	7.7	22.7	40.3	4.7	6.4	4.7	[31]
	117a	< 30	0.7	0.7	59.0	0.0	0.0	0.0	[32]
	899	33.9	10.7	50.7	34.5	7.8	8.7	6.5	[33]
	100	17-58	19.0	6.0	56.0	NR	15.0	5.0	[34]
	268	37.0	10.8	6.0	39.2	NR	NR	NR	[35]
	153	30.7	5.9	22.9	59.5	2.0	5.2	1.3	[36]
	539	35.3	NR	NR	NR	0.0	1.1	NR	[37]
	200	36.5	1.5	4.5	12.0	0.0	0.0	0.0	[38]
	1327	26.5	20.2	NS	13.5	NS	NR	NS	[39]
	518	35.2	15.5	3.7	69.5	0.6	11.2	0.6	[16]
Israel	743	33.8	1.9	8.6	69.3	NR	NR	NR	[40]
Lebanon	106a	≥ 18	0.9	2.8	52.8	0.0	0.0	0.0	[44]
Libya	328a	≥ 15	87.1	4.5	94.2	4.2	83.2	NR	[41]
Palestine	192	41.3	0.0	2.6	43.8	0.0	0.0	0.0	[42]
Saudi Arabia	297	31.0	0.7	6.1	37.7	NR	NR	NR	[43]

aEstimated prevalence using respondent-driven sampling method. All numbers were rounded to the nearest 1. n: Sample size; NR: Not reported; NS: Not studied; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 4

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus and their co-infection status among different populations from Middle East and North Africa countries between 2005 and 2015

Country	n	Mean age/age	HIV (%)	HBV (%)	HCV (%)	HIV-HBV co-infection (%)	HIV-HCV co-infection (%)	Triple infection (%)	Ref.
HIV infected individuals
Iran	64	-	-	-	-	18.8	NS	NS	[49]
	168	38.7	-	-	-	NS	87.5	NS	[50]
	1338	32-42	-	-	-	NS	78.0	NS	[51]
	106	36.6	-	-	-	20.8	67.0	NR	[52]
	80	37.0	-	-	-	11.3	33.8	25.0	[53]
	130	50.2	-	-	-	11.5	77.0	9.2	[54]
	391	-	-	-	-	14.5	72.0	7.9	[55]
	201	36.0	-	-	-	44.3	67.2	36.3	[56]
	1444	38.4	-	-	-	NS	78.4	NS	[57]
Morocco	503	39.0	-	-	-	29.4	5.4	NR	[58]
Sudan	358	35.0	-	-	-	26.8	NS	NS	[59]
Turkey	949	37.9	-	-	-	0.0	0.9	0.0	[60]
Blood donors
Cyprus	5057	34.5	0.0	3.0	0.5	0.0	0.0	0.0	[61]
Iran	6499851	-	< 0.1	0.6	0.1	NR	NR	NR	[62]
	2026628	38.0	< 0.1	0.4	0.1	NR	NR	NR	[63]
UAE	592	-	1.2	67.2	31.6	NR	NR	NR	[64]
Others
Cyprus
Soldiers	12488	34.5	0.0	2.2	0.5	0.0	0.0	0.0	[61]
Iran
HBV patients	264	41.6	0.4	-	4.5	0.4	NR	NR	[65]
HIV infected patients’ partners	168	33.2	NR	NS	NR	NS	9.5	NS	[50]
Non-injecting drug users	336	28.5	1.5	5.6	4.5	1.2	0.9	0.9	[31]
Referral from behavioral counseling center	379	29.7	4.0	2.9	35.6	0.8	3.4	0.3	[66]
Libya
General Population	9170	34.0	0.2	3.7	0.9	< 0.1	0.1	< 0.1	[67]
Medical waste handlers	300	-	0.0	2.3	2.7	0.0	0.0	0.0	[68]
Non-Medical waste handlers	300	-	0.0	0.3	0.0	0.0	0.0	0.0	[68]
Turkey
ER patients	1000	51.7	0.0	5.0	1.8	0.0	0.0	0.0	[69]
In and out-patients	97000-225000	-	0.3	33.9	1.2	NR	NR	NR	[70]

All number were rounded to the nearest 1. n: Sample size; NR: Not reported; NS: Not studied; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Full article at:  http://goo.gl/FW5TbL

  

By:  Nada M Melhem, Nour Rahhal, Rana Charide, Khalil Kreidieh, and Rolla El-Khatib

Nada M Melhem, Khalil Kreidieh, Rolla El-Khatib, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon

Nour Rahhal, Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon

Rana Charide, Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon

Author contributions: Melhem NM designed and wrote the paper; Rahhal N, Charide R and Kreidieh K reviewed the literature, prepared the tables and contributed to the write-up; El-Khatib R critically read the manuscript.

Correspondence to: Nada M Melhem, PhD, Assistant Professor of Infectious Diseases, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, 325 Van Dyck Hall, 11-0236 Riad El Solh, Beirut 1107-2020, Lebanon. bl.ude.bua@nmehlem

Telephone: +961-1-350000-4699 Fax: +961-1-744470

 

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