A low prevalence of Parkinson's disease (PD) has been reported in the Sub-Saharan Africa (SSA) region. The genetic causes and clinical features of PD in this region have been poorly described. Very few reports have examined the availability and access to evidence-based quality care for people living with PD in this region. We reviewed all publications focusing on idiopathic PD from SSA published up to May 2016 and observed a prevalence of PD ranging from 7/100,000 in Ethiopia to 67/100,000 in Nigeria. The most recent community-based study reported a mean age at onset of 69.4 years. The infrequent occurrence of mutations in established PD genes was also observed in the region. Treatments were non-existent or at best irregular. Additionally, there is a lack of well-trained medical personnel and multidisciplinary teams in most countries in this region. Drugs for treating PD are either not available or unaffordable. Large-scale genetic and epidemiological studies are therefore needed in SSA to provide further insights into the roles of genetics and other etiological factors in the pathogenesis of PD. The quality of care also requires urgent improvement to meet the basic level of care required by PD patients.
Africa South of the Sahara ; Age of Onset ; Epidemiologic Studies ; Epidemiology ; Ethiopia ; Genetics ; Humans ; Nigeria ; Parkinson Disease ; Prevalence

Zaire Ebola virus (EBOV) is a fatal human pathogen, with a high case fatality rate (CFR) averaging up to 78%. In March 2014, the World Health Organization (WHO) was made aware of a ZEBOV outbreak in rural Guinea, West Africa. Epidemiologic investigation linked the clinical and laboratory confirmed cases with the presumed first fatality of the outbreak in December 2013. EBOV from Guinea is a separate clade from other ZEBOV strains reported from the Democratic Republic of Congo (DRC) and Gabon. Since the outbreak in March, ZEBOV was also reported in Conakry, Guinea's capital and spread to other neighboring countries. In its largest outbreak, ZEBOV disease expanded through Guinea, Liberia, Sierra Leone, and Nigeria and to Spain, the USA, and the UK. The WHO declared the 2013-2015 West African Ebola epidemic a public health emergency of international concern considering its presumable capacity for further international spread. Early manifestations of EVD (Ebola virus disease) include a high fever, body aches, malaise, and fatigue. Severe diarrhea and other gastrointestinal manifestations such as vomiting were common, while bleeding was a more sporadic finding. The fatality rate was 43% and highest in patients aged > or = 45 years and the overall fitted mean incubation period was 10.3 days (95% CI 9.9~10.7). We present a review of the literature on the emergence of Ebola, and the epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed in Sierra Leone, Guinea, Liberia, Mali, the USA, and Spain, its zoonotic origin, and the transmission of ZEBOV, as well as presenting original literature on the current Ebola outbreak.
Africa, Western* ; Congo ; Diarrhea ; Ebolavirus ; Emergencies ; Epidemiology ; Fatigue ; Fever ; Gabon ; Guinea ; Hemorrhage ; Humans ; Liberia ; Mali ; Mortality ; Nigeria ; Public Health ; Sierra Leone ; Spain ; Vomiting ; World Health Organization

Malaria remains one of the leading health burdens in the developing world, especially in several sub-Saharan Africa countries; and Uganda has some of the highest recorded measures of malaria transmission intensity in the world. It is evident that the prevalence of malaria infection, the incidence of disease, and mortality from severe malaria remain very high in Uganda. Although the recent stable political and economic situation in the last few decades in Uganda supported for a fairly good appreciation of malaria control, the declines in infection, morbidity, and mortality are not sufficient to interrupt transmission and this country is among the top 4 countries with cases of malaria, especially among children under 5 years of age. In fact, Uganda, which is endemic in over 95% of the country, is a representative of challenges facing malaria control in Africa. In this study, we evaluated an active case detection program in 6 randomly selected villages, Uganda. This program covered a potential target population of 5,017 individuals. Our team screened 12,257 samples of malaria by active case detection, every 4 months, from February 2015 to January 2017 in the 6 villages (a total of 6 times). This study assessed the perceptions and practices on malaria control in Kiyuni Parish of Kyankwanzi district, Uganda. Our study presents that the incidence of malaria is sustained high despite efforts to scale-up and improve the use of LLINs and access to ACDs, based on the average incidence confirmed by RDTs.
Africa ; Africa South of the Sahara ; Child ; Health Services Needs and Demand ; Humans ; Incidence ; Malaria ; Mortality ; Prevalence ; Uganda

OBJECTIVE: Falls are a devastating consequence of Parkinson's disease (PD) and are due to motor imbalance. However, the frequency of falls and their risk factors among Nigerians with PD is not known despite the significant increase in PD cases in the country. To assess fall risk factors and frequency in Nigerian PD patients. METHODS: Using an analytical design to compare falling versus non-falling patients, 81 PD patients were assessed for clinical factors, frequency of falls, and candidate risk factors for falls according to the Tinetti Balance and Gait, Unified Parkinson's Disease Rating Scale subsection 1, and Timed Up and Go Tests. Descriptive, bivariate, and multivariate analyses were performed at the 95% confidence level. RESULTS: The mean age of participants was 65.6 ± 9.7 years. Falls were about three times (p < 0.001) more common in PD patients. Of the falling patients, 67.7% sustained injuries, 67.7% had recurrent falls and 44.9% admitted to having a fear of falling. The independent statistical predictors of fall were fear of falling [odds ratio (OR): 3.86], disease severity (OR: 1.09) and disease duration (OR: 1.01). CONCLUSION: The frequency of falls in PD patients was significantly higher when compared with the healthy adult population, and the modifiable predictor was fear of falling with a potential to significantly reduce falls when strategically addressed.
Accidental Falls* ; Adult ; Africa South of the Sahara ; Gait ; Humans ; Multivariate Analysis ; Nigeria* ; Parkinson Disease ; Risk Factors

Tungiasis is an ectoparasitic disease that is caused by the penetration of Tunga penetrans into the epidermis of the host. Tungiasis is indigenous to South Americaand the Caribbean regions, but it has spread to Latin America, India, and sub-Saharan Africa. The area of soft skin such as the soles, toes, webs and subungual regions are the favored sites for sand flea embedding. As the flea enlarges within epidermis a pruritic, painful white or erythematous papulonodule develops. A black central punctum is characteristic. A 32-year-old woman presented with a small black crust on the right sole after traveling to an endemic area(Congo). Histopathologic examination revealed the internal organs of the arthropod embedded intothe epidermis, which allowed a definitive diagnosis of tungiasis. Although tungiasis is common in endemic areas, there has been no report of tungiasis in the Korean literature. We report herein an interesting case of tungiasis in a patient after traveling to Congo.
Adult ; Africa South of the Sahara ; Arthropods ; Caribbean Region ; Congo ; Epidermis ; Female ; Humans ; India ; Latin America ; Siphonaptera ; Skin ; Toes ; Tunga ; Tungiasis

The number of people living with HIV/AIDS continues to grow, estimated to be 39.5 million as of the end of 2006, while 4.3 million people were newly infected in 2006. The proportions of women has continued to grow, currently approaching 50%. Sub-Saharan Africa continues to bear the brunt of global epidemic, comprising 63% of all infections worldwide. The most striking increases have occurred in East Asia, Eastern Europe, and Central Asia. High-risk behaviors (intravenous drug use and unprotected sex between men or with paid sex workers) are the predominant route of transmission. The number of people with HIV/AIDS continues to increase since the first report of HIV in Korea, now approaching 4,580 as of the end of 2006. The real magnitude of HIV epidemic is believed to be much larger than the recent estimates by UNAIDS shows (13,000 people with HIV infection). The prevalence among the general population is still low (less than 0.1%; probably 0.003~0.01%). The HIV epidemic in Korea shows several peculiar features: 1) a male predominance suggesting that the epidemic may still be largely confined to male homosexual community, while the transmission through heterosexual contact remains less prominent, 2) a conspicuous absence of contribution of intravenous drug use to current epidemic, and 3) a very small number of vertical transmission due to the relatively limited number of infected women. The HIV epidemic is expected to continue to grow in the foreseeable future in Korea as well as globally unless drastic efforts are made to cope with the epidemic.
Africa South of the Sahara ; Asia ; Epidemiology* ; Europe, Eastern ; Far East ; Female ; Heterosexuality ; HIV ; Homosexuality ; Humans ; Korea ; Male ; Prevalence ; Seroepidemiologic Studies ; Strikes, Employee ; Unsafe Sex

BACKGROUND: Because there has been a recent increase in refugee applications in Korea, the mental health of these refugees merits greater study. METHODS: We surveyed 129 refugees (including those in process of refugee application) and 121 migrant workers living in urban communities, using: the Patient Health Questionnaire-9 for depressive symptoms, the Impact Event Scale-Revised for post-traumatic stress disorder (PTSD) symptoms, and the health questionnaires used in 2016 Korean National Health and Nutrition Examination Survey (KNHANES). The majority of refugee subjects were from sub-Saharan Africa and Middle East. We compared the prevalence of possible depression and possible PTSD between refugees and migrant workers and refugees and age-gender matched samples from the KNHANES 2016. RESULTS: Frequency of suicidal planning during the last year was higher in the refugee group than Korean nationals, but frequency of suicidal attempt was not. High risk drinking was found in 0.8% of refugees, 6.6% of migrant workers and 27.2% of Korean nationals. Possible depression was present in 42.9% of refugee subjects, 33.3% of migrant workers, and 4.2% of Korean controls. Possible PTSD was present in 38.9% of refugees compared to 12.5% of migrant workers. Only major risk factor for depression among refugees was a traumatic event before entering Korea. CONCLUSION: Possible depression and PTSD are significantly more prevalent in refugees, compared to both migrant workers and Korean nationals. Prevalence rates are commensurate with refugee studies worldwide. Appropriate early screening and intervention schemes need to be developed for refugees entering Korea.
Adult ; Africa South of the Sahara ; Depression ; Drinking ; Humans ; Independent Living ; Korea ; Mass Screening ; Mental Health ; Middle East ; Nutrition Surveys ; Prevalence ; Refugees ; Risk Factors ; Stress Disorders, Post-Traumatic ; Transients and Migrants

BACKGROUND: Globally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries. METHODS: We pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models. RESULTS: Of the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03-1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73-0.98)] or outside [0.75 (0.64-0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children. CONCLUSIONS HAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.
Africa South of the Sahara ; Air Pollution, Indoor/adverse effects* ; Biomass ; Cooking ; Female ; Health Surveys ; Housing ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Male ; Mortality

International migration of people has risen exponentially during the past two decades. Many people travel abroad for business purposes, sightseeing, volunteer activities, immigration, education, missonary work, etc., and are exposed to vector-borne and food or water-borne parasitic diseases, especially when they are traveling to the tropical and sub-tropical areas. Recently, imported parasitic diseases have also increased in Korea due to frequent traveling by the local residents or entry of foreign workers to the country. According to the statistics from 1970 to 2008, malaria (727 cases) was the most frequently imported parasitic disease in Korea followed by gnathostomiasis (42 cases) and hydatidosis (31 cases). From 1970 to 2010, cases of ancylostomiasis (1 case), angiostrongylosis (15 cases), babesiosis (8 cases), cutaneous larva migrans (8 cases), cutaneous myiasis (2 cases), cyclosporiasis (1 case), heterophyiasis (2 cases), leishmaniasis (28 cases), loiasis (3 cases), pentastomiasis (1 case), schistosomiasis (13 cases), and syngamosis (1 case) have also been reported. Travelers to Sub-Saharan Africa, Southeast Asia, and Central and South America should be on alert against malaria and other tropical diseases. National surveillance for imported diseases started in 2001 by Korea Centers for Disease Control and Prevention (KCDC). This article reviews imported parasitic diseases in Korea with review of literature.
Africa South of the Sahara ; Ancylostomiasis ; Animals ; Asia, Southeastern ; Babesiosis ; Centers for Disease Control and Prevention (U.S.) ; Commerce ; Cyclosporiasis ; Echinococcosis ; Emigration and Immigration ; Gnathostomiasis ; Korea ; Larva Migrans ; Leishmaniasis ; Loiasis ; Malaria ; Myiasis ; Parasitic Diseases ; Schistosomiasis ; South America

Invasive cancer of the cervix is considered a preventable disease because it has a long preinvasive state, cervical cytology screening programs are currently available, and the treatment of pre-invasive lesions is effective. Cancer of the cervix is the second most common cancer among women worldwide, with an estimated 493,000 new cases and 274,000 deaths in 2002. The highest incidence rates are observed in sub-Saharan Africa, Melanesia, Latin America and the Caribbean, South-Central Asia, and South East Asia. In Korea, cervical cancer is the fifth most common cancer among women with over 3,000 new cases every year. Age-standardized incidence rate (ASR) is 15.5 per 100,000, which is lower than those in developing countries but higher than in western countries such as Europe and North America. The patients' mean parity is 2.59, and the range of age in peak incidence is 40~49 years (29.8%), followed by 50~59 years (21.9%). As the age goes on, more advanced stage cancer is frequent. Squamous cell carcinoma is the most common cell type, and adenocarcinoma is more frequent among those under 60 years old. Operation (56.0%) is the major treatment modality under stage IIa, and concurrent chemoradiation (31.6%) is the major treatment over stage IIb. The 5year survival rate is 73.9%. It is generally thought that human papillomavirus (HPV) test and HPV vaccine might play an important role in lowering the incidence of cervical cancer, and continuous epidemiologic studies will support its usefulness and efficacy.
Adenocarcinoma ; Africa South of the Sahara ; Asia ; Carcinoma, Squamous Cell ; Caribbean Region ; Developing Countries ; Epidemiologic Studies ; Epidemiology* ; Europe ; Far East ; Female ; Humans ; Incidence ; Korea ; Latin America ; Mass Screening ; Melanesia ; Middle Aged ; North America ; Parity ; Survival Rate ; Uterine Cervical Neoplasms*