Infertility or childlessness is a major reproductive health issue for females as well as males respectively. Many couples suffer from infertility worldwide and in Sub-Saharan Africa, which has a cultural preference for high fertility; women shoulder the highest infertility consequences. The objective of this review was therefore to explore socially acceptable and culturally effective reproductive health strategies for the social management of infertility in sub-Sahara Africa. Different databases were searched to source articles on infertility in Sub-Saharan Africa. The databases included Medline, Pubmed and Fudan University library. Google scholar was also utilized to get additional relevant articles. Titles and abstracts of the articles searched were critically evaluated for relevance based on the inclusion criteria. Final extraction of the articles was done by getting only those studies that met the inclusion criteria. Twenty articles were identified and five were included in this review. The findings reveal three main themes: perception, health seeking behavior and the social impact of infertility. In many Sub-Saharan Africa societies, there is negative perception of infertility problem as such those affected do not seek medical attention early. There is also a disproportionate social impact of infertility on women in the region. In Sub-Saharan Africa, high value is placed on children and those who are infertile are greatly stigmatized. In such a setting, the concept of reproductive health should include policies which could make it possible for couples and the whole society aware of the reality of infertility as a reproductive health problem and seek medical attention early.

BackgroundMalawi is a low-income country with high Tuberculosis (TB) burden. TB diagnosis delay and untimely initiation of treatment is still a major problem in Malawi which could increase the risk of tuberculosis transmission in the communities. This study investigated factors related to the diagnostic delay of tuberculosis from TB healthcare providers in the northern region of Malawi.MethodsNine focus group discussions were conducted with 57 participants in total. The participants were healthcare cadres including district TB officers, clinical officers, TB nurses, laboratory technicians and Health Surveillance Assistants (HSAs). NVivo (11.0) software was used for data analysis.ResultsThe factors related to diagnostic delay were categorized into three themes: client factors, institutional factors and healthcare provider related factors. Client’s stigma and fear for HIV test, resource shortage within healthcare institutions and the healthcare workers’ poor attitude against potential patients were among the most influential factors behind the TB diagnostic delay.ConclusionsThe TB control strategies should aim to reduce HIV stigma, improve resource supply and improve TB healthcare workers’ morale in order to achieve timely TB diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0279-1) contains supplementary material, which is available to authorized users.

IntroductionSickle cell disease (SCD) remains a major cause of childhood mortality and morbidity in Malawi. However, literature to comprehensively describe the disease in the paediatric population is lacking.MethodsA retrospective review of clinical files of children with SCD was conducted. Descriptive statistics were performed to summarise the data. χ2 or Fisher’s exact test was used to look for significant associations between predictor variables and outcome variables (case fatality and length of hospital stay). Predictor variables that were significantly associated with outcome variables (p≤0.05) in a χ2 or Fisher’s exact test were carried forward for analysis in a binary logistic regression. A multivariable binary logistic regression was used to identify covariates that independently predicted length of hospital stay.ResultsThere were 16 333 paediatric hospitalisations during the study period. Of these, 512 were patients with SCD representing 3.1% (95% CI: 2.9%- 3.4%). Sixty-eight of the 512 children (13.3%; 95% CI: 10.5% - 16.5%) were newly diagnosed cases. Of these, only 13.2% (95% CI: 6.2% - 23.6%) were diagnosed in infancy. Anaemia (94.1%), sepsis (79.5%) and painful crisis (54.3%) were the most recorded clinical features. The mean values of haematological parameters were as follows: haemoglobin (g/dL) 6.4 (SD=1.9), platelets (×109/L) 358.8 (SD=200.9) while median value for white cell count (×109/L) was 23.5 (IQR: 18.0–31.2). Case fatality was 1.4% (95% CI: 0.6% - 2.8%)and 15.2% (95% CI: 12.2% -18.6%) of the children had a prolonged hospital stay (>5 days). Patients with painful crisis were 1.7 (95% CI: 1.02 - 2.86) times more likely to have prolonged hospital stay than those without the complication.ConclusionAnaemia, sepsis and painful crisis were the most common clinical features paediatric patients with SCD presented with. Patients with painful crisis were more likely to have prolonged hospital stay. Delayed diagnosis of SCD is a problem that needs immediate attention in this setting. Although somewhat encouraging, the relatively low in-hospital mortality among SCD children may under-report the true mortality from the disease considering community deaths and deaths occurring before SCD diagnosis is made.