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Africa, the poorest and youngest populated region in the world, is set to see a rapid increase in the number of older persons in the coming three decades. While the expected increase in the prevalence of non-communicable diseases is already evident, sparse data exist on the geriatric syndromes. Healthcare systems vary considerably between the countries, with universal healthcare available in only a handful. Public healthcare is generally underfunded, overburdened and unprepared for the care of older persons and private care unaffordable. Training in Geriatric Medicine is limited to a small number of facilities in a few countries. Despite the African Union Policy Framework and Plan of Action on Ageing, there has been very little progress on the implementation of age-sensitive policies. There is an urgent need to improve care of older persons in the region. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa. [ABSTRACT FROM AUTHOR]

English abstract: This article is a feminist theoretical examination of the nexus between migrants' health and gender and attempts to fill the gap between existing gendered health and migration policies. Gender-specific challenges faced by female migrants include poor sexual and reproductive health rights, infant mortality, nutritional disorders, and violence. Non-communicable diseases provoke interruption of care in the absence of suitable health care systems and services. As policy makers struggle to develop suitable migration policies, the needs of women often fall through the cracks. Major findings are that migration policy design from micro to macro levels does not align with ratified international protocols on health, resulting in multiple vulnerabilities of female migrants. The study concludes that bilateral migration policy agreements should be comprehensive, binding, gender-sensitive, and participatory. Spanish abstract: Este es un examen teórico feminista del nexo entre salud de los migrantes y género, e intenta llenar el vacío entre las políticas existentes de salud y migración de género. Las mujeres migrantes enfrentan desafíos específicos de género incluyendo limitados derechos de salud sexual y reproductiva, mortalidad infantil, trastornos nutricionales y violencia. Las necesidades de las mujeres a menudo se quedan atrás en el desarrollo de políticas de migración adecuadas. Los principales hallazgos son que el diseño de la política de migración de los niveles micro a macro no se alinea con los protocolos internacionales de salud ratificados, resultando en múltiples vulnerabilidades de mujeres migrantes. El estudio concluye que los acuerdos de política bilateral de migración deben ser integrales, vinculantes, sensible al género y participativos. English abstract: This article is a feminist theoretical examination of the nexus between migrants' health and gender and attempts to fill the gap between existing gendered health and migration policies. Gender-specific challenges faced by female migrants include poor sexual and reproductive health rights, infant mortality, nutritional disorders, and violence. Non-communicable diseases provoke interruption of care in the absence of suitable health care systems and services. As policy makers struggle to develop suitable migration policies, the needs of women often fall through the cracks. Major findings are that migration policy design from micro to macro levels does not align with ratified international protocols on health, resulting in multiple vulnerabilities of female migrants. The study concludes that bilateral migration policy agreements should be comprehensive, binding, gender-sensitive, and participatory. Spanish abstract: Este es un examen teórico feminista del nexo entre salud de los migrantes y género, e intenta llenar el vacío entre las políticas existentes de salud y migración de género. Las mujeres migrantes enfrentan desafíos específicos de género incluyendo limitados derechos de salud sexual y reproductiva, mortalidad infantil, trastornos nutricionales y violencia. Las necesidades de las mujeres a menudo se quedan atrás en el desarrollo de políticas de migración adecuadas. Los principales hallazgos son que el diseño de la política de migración de los niveles micro a macro no se alinea con los protocolos internacionales de salud ratificados, resultando en múltiples vulnerabilidades de mujeres migrantes. El estudio concluye que los acuerdos de política bilateral de migración deben ser integrales, vinculantes, sensible al género y participativos. French abstract: Cet article théorique examine, dans une perspective féministe, les liens entre la santé des migrants et le genre et tente de combler le fossé entre les politiques migratoires et de santé. Les défi s spécifiques des femmes migrantes incluent l'accès à la santé sexuelle et reproductive, la mortalité infantile, les troubles nutritionnels et la violence. Leurs besoins sont souvent omis dans l'élaboration des politiques migratoires. Cet article montre que la conception de la politique migratoire à partir d'une échelle micro vers un niveau macro ne correspond pas aux protocoles internationaux ratifiés sur la santé, ce qui entraîne de multiples vulnérabilités des femmes migrantes. Il conclut que les accords bilatéraux en matière de migration doivent être exhaustifs, contraignants, sensibles au genre et participatifs. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the barriers to primary health-care services for noncommunicable diseases in the African region as of December 2020. Other topics include the World Health Organization Package of Essential Noncommunicable Disease Interventions (WHO PEN), the priority conditions of the program like cancer, diabetes, and cardiovascular diseases, as well as other topics like resource mobilization, advocacy, and engagement with multisectoral stakeholders.

We sought to characterize non-communicable disease (NCD)-related and overall health service use among African and Caribbean immigrants living with HIV between April 1, 2010 and March 31, 2013. We conducted two population-based analyses using Ontario’s linked administrative health databases. We studied 1525 persons with HIV originally from Africa and the Caribbean. Compared with non-immigrants with HIV (n = 11,931), African and Caribbean immigrants had lower rates of hospital admissions, emergency department visits and non-HIV specific ambulatory care visits, and higher rates of health service use for hypertension and diabetes. Compared with HIV-negative individuals from these regions (n = 228,925), African and Caribbean immigrants with HIV had higher rates of health service use for chronic obstructive pulmonary disease [rate ratio (RR) 1.78; 95% confidence interval (CI) 1.36-2.34] and malignancy (RR 1.20; 95% CI 1.19-1.43), and greater frequency of hospitalizations for mental health illness (RR 3.33; 95% CI 2.44-4.56), diabetes (RR 1.37; 95% CI 1.09-1.71) and hypertension (RR 1.85; 95% CI 1.46-2.34). African and Caribbean immigrants with HIV have higher rates of health service use for certain NCDs than non-immigrants with HIV. The evaluation of health services for African and Caribbean immigrants with HIV should include indicators of NCD care that disproportionately affect this population. [ABSTRACT FROM AUTHOR]

With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being managed among PLHIV. Developing integrated chronic care models that effectively prevent and treat NCDs among PLHIV requires an understanding of the current patterns of care delivery and the major barriers and facilitators to health care. We present a systematic review protocol to synthesize studies of healthcare delivery for an important subset of NCDs, cardiovascular and metabolic diseases (CMDs), among African PLHIV. Methods/design: We plan to search electronic databases and reference lists of relevant studies published in African settings from January 2003 to the present. Studies will be considered if they address one or both of our major objectives and focus on health care for one or more of six interrelated CMDs (ischemic heart disease, stroke, heart failure, hypertension, diabetes, and hyperlipidemia) in PLHIV. Our first objective will be to estimate proportions of CMD patients along the "cascade of care"-i.e., screened, diagnosed, aware of the diagnosis, initiated on treatment, adherent to treatment, and with controlled disease. Our second objective will be to identify unique barriers and facilitators to health care faced by PLHIV in African countries. For studies deemed eligible for inclusion, we will assess study quality and risk of bias using previously published criteria. We will extract study data using standardized instruments. We will meta-analyze quantitative data at each level of the cascade of care for each CMD (first objective). We will use meta-synthesis techniques to understand and integrate qualitative data on health-related behaviors (second objective). Discussion: CMDs and other NCDs are becoming major health concerns for African PLHIV. The results of our review will inform the development of research into chronic care models that integrate care for HIV/AIDS and CMDs among PLHIV. Our findings will be highly relevant to health policymakers, administrators, and practitioners in African settings. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained.Methods: We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region.Results: The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa.Conclusion: The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region. [ABSTRACT FROM AUTHOR]

Sub-Saharan African countries now face the double burden of Non Communicable and Communicable Diseases. This situation represents a major threat to fragile health systems and emphasises the need for innovative integrative approaches to health care delivery. Health services need to be reorganised to address populations' needs holistically and effectively leverage resources in already resource-limited settings. Access and delivery of quality health care should be reinforced and implemented at primary health care level within the framework of health system strengthening. Competencies need to be developed around services provided rather than specific diseases. New models of integration within the health sector and other sectors should be explored and further evidence generated to inform policy and practice to combat the double burden. [ABSTRACT FROM AUTHOR]

The authors reflect on sociocultural infrastructure and communicating identity and health in Africa as of January 2014, focusing on the social aspects of health-related decisions and efforts to reduce a global disease burden by improving health and health care practices across Africa. The World Health Organization (WHO) and communicable diseases are mentioned, along with international measures to combat the number of deaths which occur in Africa from noncommunicable diseases.

With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa. [ABSTRACT FROM AUTHOR]