Journal articles on the topic 'Medical care – Africa, Sub-Saharan'
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Gisselquist, D. "Denialism undermines AIDS prevention in sub-Saharan Africa." International Journal of STD & AIDS 19, no. 10 (October 2008): 649–55. http://dx.doi.org/10.1258/ijsa.2008.008180.
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Some denialists, widely reviled, contend that HIV does not cause AIDS. Other denialists, widely respected, contend that HIV transmits so poorly through trace blood exposures that iatrogenic infections are rare. This second group of denialists has had a corrosive effect on public health and HIV programmes in sub-Saharan Africa. Guided by this second group of denialists, no African government has investigated unexplained HIV infections. Denialists have withheld and ignored research findings showing that non-sexual risks account for substantial proportions of HIV infections in Africa. Denialists have promoted invasive procedures for HIV prevention in Africa – injections for sexually transmitted infections, and adult male circumcision – without addressing unreliable sterilization of reused instruments. By denying that health care causes more than rare infections, denialists blame (stigmatize) HIV-positive African adults for causing their own infections through sexual behaviour. Denialism must be overcome to ensure safe health care and to combat HIV-related stigma in Africa.
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Faruk, Nasir, N. T. Surajudeen-Bakinde, Abubakar Abdulkarim, Abdulkarim Ayopo Oloyede, Lukman Olawoyin, Olayiwola W. Bello, Segun I. Popoola, and Thierry O. C. Edoh. "Rural Healthcare Delivery in Sub-Saharan Africa." International Journal of Healthcare Information Systems and Informatics 15, no. 3 (July 2020): 1–21. http://dx.doi.org/10.4018/ijhisi.2020070101.
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Access to quality healthcare is a major problem in Sub-Saharan Africa with a doctor-to-patient ratio as high as 1:50,000, which is far above the recommended ratio by the World Health Organization (WHO) which is 1:600. This has been aggravated by the lack of access to critical infrastructures such as the health care facilities, roads, electricity, and many other factors. Even if these infrastructures are provided, the number of medical practitioners to cater for the growing population of these countries is not sufficient. In this article, how information and communication technology (ICT) can be used to drive a sustainable health care delivery system through the introduction and promotion of Virtual Clinics and various health information systems such as mobile health and electronic health record systems into the healthcare industry in Sub-Saharan Africa is presented. Furthermore, the article suggests ways of attaining successful implementation of telemedicine applications /services and remote health care facilities in Africa.
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Gisselquist, David, Richard Rothenberg, John Potterat, and Ernest Drucker. "HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission." International Journal of STD & AIDS 13, no. 10 (October 1, 2002): 657–66. http://dx.doi.org/10.1258/095646202760326390.
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An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%–40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.
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Ekenze, Sebastian O., Okechukwu O. Onumaegbu, and Okechukwu E. Nwankwo. "The Current Status of International Partnerships for Child Surgery in Sub-Saharan Africa." International Surgery 99, no. 5 (September 1, 2014): 616–22. http://dx.doi.org/10.9738/intsurg-d-13-00244.1.
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Abstract Disparity still exists in the surgical care between sub-Saharan Africa and developed countries. Several international initiatives have been undertaken in the past decades to address the disparity. This study looks at the impact of these programs in child surgery in Sub-Saharan Africa. Review of electronic databases Medline and African Index Medicus on international partnerships for child surgery in Sub-Saharan Africa was undertaken. Four types of international initiatives were identified and consist of periodic medical missions; partnerships between foreign medical institutions or charities and local institutions; international health electives by surgical residents; and training of individual surgeons from developing countries in foreign institutions. The results of these efforts were variable, but sustainability and self-reliance of host nations were limited. Sociocultural factors, dearth of facilities, and lack of local governments' commitment were main impediments to effective local development or transfer of modern protocols of surgical management and improvement of pediatric surgical care at the host community level. Current initiatives may need improvements with better understanding of the sociocultural dynamics and local politics of the host nation, and improved host nation involvement and commitment. This may engender development of locally controlled viable services and sustainable high level of care.
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Limbole Bakilo, Emmanuel. "Natural Evolution of a Marfan’s Syndrome in a Medical Desert in Sub-Saharan Africa: Case Report." Journal of Quality in Health Care & Economics 5, no. 3 (2022): 1–3. http://dx.doi.org/10.23880/jqhe-16000275.
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Marfan syndrome is an autosomal dominant connective tissue disorder associated with a mutation in the Fibrillin-1 (FBN1) gene on chromosome 15. It is a rare disease that affects one in 3,000 to 5,000 people. We describe here the case of a 35-year-old young man suffering from this syndrome and whose diagnosis was made at the terminal stage of the evolution in an environment lacking any means of diagnosis and care in sub-Saharan Africa.
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Groups, African Pathologists' Summit Working. "Proceedings of the African Pathologists Summit; March 22–23, 2013; Dakar, Senegal: A Summary." Archives of Pathology & Laboratory Medicine 139, no. 1 (June 25, 2014): 126–32. http://dx.doi.org/10.5858/arpa.2013-0732-cc.
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Context This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer. Objectives To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them. Participants Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa–United States and Canadian Academy of Pathology Initiative; International Academy of Pathology; International Network for Cancer Treatment and Research; National Cancer Institute; National Health and Laboratory Service of South Africa; Nigerian Postgraduate Medical College; Royal College of Pathologists; West African Division of the International Academy of Pathology; and Faculty of Laboratory Medicine of the West African College of Physicians. Evidence Information on the status of the practice of pathology was based on the experience of the participants, who are current or past practitioners of pathology or are involved in pathology education and research in Sub-Saharan Africa. Consensus Process The deliberations were carried out through presentations and working discussion groups. Conclusions The significant lack of professional and technical personnel, inadequate infrastructure, limited training opportunities, poor funding of pathology services in Sub-Saharan Africa, and their significant impact on patient care were noted. The urgency of addressing these issues was recognized, and the recommendations that were made are contained in this report.
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Ahinkorah, Bright Opoku, Eugene Budu, Abdul-Aziz Seidu, Ebenezer Agbaglo, Collins Adu, Edward Kwabena Ameyaw, Irene Gyamfuah Ampomah, Anita Gracious Archer, Kwaku Kissah-Korsah, and Sanni Yaya. "Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in sub-Saharan Africa: A multilevel modelling of Demographic and Health Surveys." PLOS ONE 16, no. 2 (February 8, 2021): e0244395. http://dx.doi.org/10.1371/journal.pone.0244395.
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Introduction The success of current policies and interventions on providing effective access to treatment for childhood illnesses hinges on families’ decisions relating to healthcare access. In sub-Saharan Africa (SSA), there is an uneven distribution of child healthcare services. We investigated the role played by barriers to healthcare accessibility in healthcare seeking for childhood illnesses among childbearing women in SSA. Materials and methods Data on 223,184 children under five were extracted from Demographic and Health Surveys of 29 sub-Saharan African countries, conducted between 2010 and 2018. The outcome variable for the study was healthcare seeking for childhood illnesses. The data were analyzed using Stata version 14.2 for windows. Chi-square test of independence and a two-level multivariable multilevel modelling were carried out to generate the results. Statistical significance was pegged at p<0.05. We relied on ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) statement in writing the manuscript. Results Eighty-five percent (85.5%) of women in SSA sought healthcare for childhood illnesses, with the highest and lowest prevalence in Gabon (75.0%) and Zambia (92.6%) respectively. In terms of the barriers to healthcare access, we found that women who perceived getting money for medical care for self as a big problem [AOR = 0.81 CI = 0.78–0.83] and considered going for medical care alone as a big problem [AOR = 0.94, CI = 0.91–0.97] had lower odds of seeking healthcare for their children, compared to those who considered these as not a big problem. Other factors that predicted healthcare seeking for childhood illnesses were size of the child at birth, birth order, age, level of community literacy, community socio-economic status, place of residence, household head, and decision-maker for healthcare. Conclusion The study revealed a relationship between barriers to healthcare access and healthcare seeking for childhood illnesses in sub-Saharan Africa. Other individual and community level factors also predicted healthcare seeking for childhood illnesses in sub-Saharan Africa. This suggests that interventions aimed at improving child healthcare in sub-Saharan Africa need to focus on these factors.
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Mbonu, Ngozi C., Bart van den Borne, and Nanne K. De Vries. "Stigma of People with HIV/AIDS in Sub-Saharan Africa: A Literature Review." Journal of Tropical Medicine 2009 (2009): 1–14. http://dx.doi.org/10.1155/2009/145891.
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The aim of this literature review is to elucidate what is known about HIV/AIDS and stigma in Sub-Saharan Africa. Literature about HIV/AIDS and stigma in Sub-Saharan Africa was systematically searched in Pubmed, Medscape, and Psycinfo up to March 31, 2009. No starting date limit was specified. The material was analyzed using Gilmore and Somerville's (1994) four processes of stigmatizing responses: the definition of the problem HIV/AIDS, identification of people living with HIV/AIDS (PLWHA), linking HIV/AIDS to immorality and other negative characteristics, and finally behavioural consequences of stigma (distancing, isolation, discrimination in care). It was found that the cultural construction of HIV/AIDS, based on beliefs about contamination, sexuality, and religion, plays a crucial role and contributes to the strength of distancing reactions and discrimination in society. Stigma prevents the delivery of effective social and medical care (including taking antiretroviral therapy) and also enhances the number of HIV infections. More qualitative studies on HIV/AIDS stigma including stigma in health care institutions in Sub-Saharan Africa are recommended.
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Reid, S. "Increase in clinical prevalence of AIDS implies increase in unsafe medical injections." International Journal of STD & AIDS 20, no. 5 (May 2009): 295–99. http://dx.doi.org/10.1258/ijsa.2008.008441.
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A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12–17%, and up to 34–47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa.
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Bagayoko, C. O., A. Geissbuhler, and G. Bediang. "Medical Decision Support Systems in Africa." Yearbook of Medical Informatics 19, no. 01 (August 2010): 47–54. http://dx.doi.org/10.1055/s-0038-1638688.
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Summary Objective: To present an overview of the current state of computerbased medical decision support systems in Africa in the areas of public health, patient care, and consumer support. Methods: Scientific and gray literature reviews complemented by expert interviews. Results: Various domains of decision support are developed and deployed in Sub-Saharan Africa: public health information systems, clinical decision-support systems, and patient-centred decisionsupport systems. Conclusions: Until recently, most of these systems have been deployed by international organizations without a real ownership policy entrusted to the African stakeholders. Many of these endeavours have remained or ceased at the experimentation stage. The multiplicity of organizations has led to the deployment of fragmented systems causing serious interoperability problems. In addition to basic infrastructures, these studies also highlight the importance of good organization, training and support, as key to the success and sustainability of these decision support systems.
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Bentounsi, Zineb, Sharaf Sheik-Ali, Grace Drury, and Chris Lavy. "Surgical care in district hospitals in sub-Saharan Africa: a scoping review." BMJ Open 11, no. 3 (March 2021): e042862. http://dx.doi.org/10.1136/bmjopen-2020-042862.
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ObjectiveTo provide a general overview of the reported current surgical capacity and delivery in order to advance current knowledge and suggest targets for further development and research within the region of sub-Saharan Africa.DesignScoping review.SettingDistrict hospitals in sub-Saharan Africa.Data sourcesPubMed and Ovid EMBASE from January 2000 to December 2019.Study selectionStudies were included if they contained information about types of surgical procedures performed, number of operations per year, types of anaesthesia delivered, cadres of surgical/anaesthesia providers and/or patients’ outcomes.ResultsThe 52 articles included in analysis provided information about 16 countries. District hospitals were a group of diverse institutions ranging from 21 to 371 beds. The three most frequently reported procedures were caesarean section, laparotomy and hernia repair, but a wide range of orthopaedics, plastic surgery and neurosurgery procedures were also mentioned. The number of operations performed per year per district hospital ranged from 239 to 5233. The most mentioned anaesthesia providers were non-physician clinicians trained in anaesthesia. They deliver mainly general and spinal anaesthesia. Depending on countries, articles referred to different surgical care providers: specialist surgeons, medical officers and non-physician clinicians. 15 articles reported perioperative complications among which surgical site infection was the most frequent. Fifteen articles reported perioperative deaths of which the leading causes were sepsis, haemorrhage and anaesthesia complications.ConclusionDistrict hospitals play a significant role in sub-Saharan Africa, providing both emergency and elective surgeries. Most procedures are done under general or spinal anaesthesia, often administered by non-physician clinicians. Depending on countries, surgical care may be provided by medical officers, specialist surgeons and/or non-physician clinicians. Research on safety, quality and volume of surgical and anaesthesia care in this setting is scarce, and more attention to these questions is required.
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Grosse Frie, Kirstin, Hatouma Samoura, Samba Diop, Bakarou Kamate, Cheick Bougadari Traore, Brahima Malle, Bourama Coulibaly, and Eva Johanna Kantelhardt. "Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa Perspectives from Women and Patients in Bamako, Mali." Breast Care 13, no. 1 (2018): 39–43. http://dx.doi.org/10.1159/000481087.
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Background: Breast cancer, the most common cancer among women worldwide, has a high mortality rate in low-income countries. In sub-Saharan Africa, most breast cancer patients are diagnosed with advanced disease. Some studies have quantified the time delay to diagnosis in sub-Saharan Africa, but very few have used qualitative methods to understand barriers leading to delay. This study analyses barriers throughout a breast cancer patient's pathway from symptom recognition to treatment in Mali. Method: Three focus group discussions were conducted. The model of pathways to treatment was used to structure the results into 4 time intervals: appraisal, help-seeking, diagnosis, and treatment, with a focus on barriers during each interval. Results: The main barriers during the appraisal interval were a low level of breast cancer knowledge among women, their families, and medical professionals, and during the help-seeking interval, mistrust in the community health care centers and economic hardship. Barriers during the diagnosis interval were low quality of health care services and lack of social support, and during the pretreatment interval high costs and lack of specialized services. Conclusion: Multilevel interventions are needed to ensure access, availability, and affordability of a minimum standard of care for breast cancer patients in sub-Saharan Africa.
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Ekenze, Sebastian O. "Funding paediatric surgery procedures in sub-Saharan Africa." Malawi Medical Journal 31, no. 3 (September 3, 2019): 233–39. http://dx.doi.org/10.4314/mmj.v31i3.13.
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BackgroundIn sub-Saharan Africa, there is a growing awareness of the burden of paediatric surgical diseases. This has highlighted the large discrepancy between the capacity to treat and the ability to afford treatment, and the effect of this problem on access to care. This review focuses on the sources and challenges of funding paediatric surgical procedures in sub-Saharan Africa. MethodsWe undertook a search for studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review and data abstraction were completed and resulting data were analysed using Statistical Package for Social Sciences (SPSS) software. ResultsThirty-five studies met our inclusion criteria and were reviewed. The countries that were predominantly emphasized in the publications reviewed were Nigeria, South Africa, Kenya, Ghana and Uganda. The paediatric surgical procedures involved general paediatric surgery/urology, cardiac surgery, neurosurgery, oncology, plastics, ophthalmology, orthopaedics and otorhinolaryngology. The mean cost of these procedures ranged from 60 to 21,140 United States Dollars (USD). The source of funding for these procedures was mostly out-of-pocket payments (OOPs) by the patient’s family in 32 studies, (91.4%) and medical mission/non-governmental organizations (NGOs) in 21 (60%) studies. This pattern did not differ appreciably between the articles published in the initial and latter 5 years of the study period, although there was a trend towards a reduction in OOP funding. Improvements in healthcare funding by individual countries supported by international organizations and charities were the predominant suggested solutions to challenges in funding.ConclusionWhile considering the potential limitations created by diversity in study design, the reviewed publications indicate that funding for paediatric surgical procedures in sub-Saharan Africa is mostly by OOPs made by families of the patients. This may result in limited access to some procedures. Coordinated efforts, and collaboration between individual countries and international agencies, may help to reduce OOP funding and thus improve access to critical procedures.
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Ahmed, Mushtaq, Camer W. Vellani, and Alex O. Awiti. "Medical Education: Meeting the Challenge of Implementing Primary Health Care in Sub-Saharan Africa." Infectious Disease Clinics of North America 25, no. 2 (June 2011): 411–20. http://dx.doi.org/10.1016/j.idc.2011.02.011.
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Orem, Jackson. "Building Modern Cancer Care Services in Sub-Saharan Africa Based on a Clinical-Research Care Model." American Society of Clinical Oncology Educational Book, no. 42 (April 2022): 1–6. http://dx.doi.org/10.1200/edbk_349953.
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Cancer is as old as humankind; there are examples of cancer treatment in ancient Egyptian civilizations. Globally, there has been rapid evolution of oncologic practices over many decades using different modalities, their complexities notwithstanding. These developments have resulted in visible improvements in outcomes for a complex medical condition.
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Fish, Madeleine, Jeannette Parkes, Nazima Dharsee, Scott Dryden-Peterson, Jason Efstathiou, Lowell Schnipper, Bruce Chabner, and Aparna R. Parikh. "The Program for Enhanced Training in Cancer: An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa." JCO Global Oncology 6, Supplement_1 (July 2020): 13. http://dx.doi.org/10.1200/go.20.70000.
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PURPOSE Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals as a result of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. METHODS In its initial 2 years (2018 and 2019), the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of 14 fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants before arrival and upon departure, and 8 participated in semistructured interviews. RESULTS Five themes emerged from the qualitative data: expectations of POETIC, differences in oncology between the United States and sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care, research development, and collaboration among medical, radiation, and surgical oncologists. The time in Boston modeled a research infrastructure that participants expressed interest in emulating at their home hospitals. In addition, the fellowship inspired some participants to address prevention and survivorship efforts in their home countries. From the quantitative data, feedback was primarily around logistical areas for improvement. CONCLUSION POETIC was found to be feasible and valuable. The results from the first years justify the program’s continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future work will involve long-term follow up with participants and the development of an alumni network.
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Lawn, Stephen D. "Serological Diagnostic Assays for HIV-Associated Tuberculosis in Sub-Saharan Africa?" Clinical and Vaccine Immunology 21, no. 6 (April 16, 2014): 787–90. http://dx.doi.org/10.1128/cvi.00201-14.
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ABSTRACTIn this issue ofClinical and Vaccine Immunology, Siev and colleagues present an evaluation of antibody responses to four immunodominant proteins ofMycobacterium tuberculosisin patients with HIV-associated pulmonary tuberculosis (TB) in South Africa (M. Siev, D. Wilson, S. Kainth, V. O. Kasprowicz, C. M. Feintuch, E. Jenny-Avital, and J. J. Achkar, 21:791–798, 2014, doi:http://dx.doi.org/10.1128/CVI.00805-13). This commentary discusses the enormous need for simple point-of-care assays for tuberculosis (TB) diagnosis in patients with and without HIV coinfection in high-burden settings and considers the potential role of serological assays and the huge challenges inherent in developing and validating such assays.
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Rienhoff, O., and G. Kouematchoua Tchuitcheu. "Options for Diabetes Management in Sub-Saharan Africa with an Electronic Medical Record System." Methods of Information in Medicine 50, no. 01 (2011): 11–22. http://dx.doi.org/10.3414/me09-01-0021.
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Summary Background: An increase of diabetes prevalence of up to 80% is predicted in subSaharan Africa (SSA) by 2025 exceeding the worldwide 55%. Mortality rates of diabetes and HIV/AIDS are similar. Diabetes shares several common factors with HIV/AIDS and multidrug-resistant tuberculosis (MDR-TB). The latter two health problems have been efficiently managed by an open source electronic medical record system (EMRS) in Latin America. Therefore a similar solution for diabetes in SSA could be extremely helpful. Objectives: The aim was to design and validate a conceptual model for an EMRS to improve diabetes management in SSA making use of the HIV and TB experience. Methods: A review of the literature addressed diabetes care and management in SSA as well as existing examples of information and communication technology (ICT) use in SSA. Based on a need assessment conducted in SSA a conceptual model based on the traditionally structured healthcare system in SSA was mapped into a three-layer structure. Application modules were derived and a demonstrator programmed based on an open source EMRS. Then the approach was validated by SSA experts. Results: A conceptual model could be specified and validated which enhances a problem-oriented approach to diabetes management processes. The prototyp EMRS demonstrates options for a patient portal and simulation tools for education of health professional and patients in SSA. Conclusion: It is possible to find IT solutions for diabetes care in SSA which follow the same efficiency concepts as HIV or TB modules in Latin America. The local efficiency and sustainability of the solution will, however, depend on training and changes in work behavior.
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Honsel, Vasco, Djamal Khimoud, Brigitte Ranque, Lucile Offredo, Laure Joseph, Jacques Pouchot, and Jean-Benoît Arlet. "Comparison between Adult Patients with Sickle Cell Disease of Sub-Saharan African Origin Born in Metropolitan France and in Sub-Saharan Africa." Journal of Clinical Medicine 8, no. 12 (December 9, 2019): 2173. http://dx.doi.org/10.3390/jcm8122173.
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Sickle cell disease (SCD) prevalence has increased rapidly in Europe as a result of an increase in the life expectancy of these patients and the arrival of SCD migrants from Africa. The aim of our study was to compare the phenotypes of adult patients born in Sub-Saharan Africa (SSA) who migrated to France with those of patients with the same origin who were born in France. This single-center observational study compared the demographic, clinical and biological characteristics of SCD adult patients of SSA origin who were born in France or SSA. Data were collected from computerized medical charts. Groups were compared using multivariate logistic regression with adjustment for age, gender and type of SCD. Of the 323 SCD patients followed in our center, 235 were enrolled, including 111 patients born in France and 124 patients born in SSA. SCD genotypes were balanced between groups. Patients born in Africa were older (median age 32.1 (24.4–39) vs. 25.6 (22.1–30.5) years, p < 0.001) and more often women (n = 75 (60.5%) vs. 48 (43.2%), p = 0.008). The median age at arrival in France was 18 years (13–23). The median height was lower among patients born in SSA (169 (163–175) vs. 174.5 cm (168–179), p < 0.001). Over their lifetimes, patients born in France had more acute chest syndromes (median number 2 (1–4) vs. 1 (0–3), p = 0.002), with the first episode occurring earlier (19 (11.6–22.3) vs. 24 (18.4–29.5) years, p < 0.007), and were admitted to intensive care units more often (53.3% vs. 34.9%, p = 0.006). This difference was more pronounced in the SS/Sβ0 population. Conversely, patients born in SSA had more skin ulcers (19.4% vs. 6.3%, p = 0.03). No significant differences were found in social and occupational insertion or other complications between the two groups. Patients born in SSA had a less severe disease phenotype regardless of their age than those born in France. This difference could be related to a survival bias occurring in Africa during childhood and migration to Europe that selected the least severe phenotypes.
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Aynalem, Yared Asmare, Getaneh Baye Mulu, Tadesse Yirga Akalu, and Wondimeneh Shibabaw Shiferaw. "Prevalence of neonatal hyperbilirubinaemia and its association with glucose-6-phosphate dehydrogenase deficiency and blood-type incompatibility in sub-Saharan Africa: a systematic review and meta-analysis." BMJ Paediatrics Open 4, no. 1 (September 2020): e000750. http://dx.doi.org/10.1136/bmjpo-2020-000750.
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BackgroundHyperbilirubinaemia is a silent cause of newborn disease and death worldwide. However, studies of the disease in sub-Saharan Africa are highly variable with respect to its prevalence. Hence, this study aimed to estimate the overall magnitude of neonatal hyperbilirubinaemia and its association with glucose-6-phosphate dehydrogenase (G6PD) deficiency and blood-type incompatibility in sub-Saharan Africa.MethodsPubMed, Scopus, Google Scholar and the Cochrane Review were systematically searched online to retrieve hyperbilirubinaemia-related articles. All observational studies reported the prevalence of hyperbilirubinaemia in sub-Saharan Africa were included for analysis and excluded if the study failed to determine the desired outcome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Heterogeneity across the included studies was evaluated using the inconsistency index (I2). Subgroup and meta- regression analysis were also done. Publication bias was examined by funnel plot and the Egger’s regression test. The random-effect model was fitted to estimate the pooled prevalence of neonatal hyperbilirubinaemia. The meta-analysis was performed using the STATA V.14 software.ResultsA total of 30 486 studies were collected from the different databases and 10 articles were included for the final analysis. The overall magnitude of neonatal hyperbilirubinaemia was 28.08% (95% CI20.23 to 35.94, I2=83.2) in sub-Saharan Africa. Neonates with G6PD deficiency (OR 2.42, 95% CI 1.64 to 3.56, I2=37%) and neonates that had a blood type that was incompatible with their mother’s (OR 3.3, (95% CI 1.96 to 5.72, I2=84%) were more likely to develop hyperbilirubinaemia.ConclusionThe failure to prevent and screen G6PD deficiency and blood-type incompatibility with their mother’s results in high burden of neonatal hyperbilirubinaemia in sub-Saharan Africa. Therefore, early identification and care strategies should be developed to the affected neonates with G6PD deficiency and blood-type incompatibility with their mother’s to address long-term medical and scholastic damages among those exposed to hyperbilirubinaemia
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Bastard, Mathieu, Nathalie Nicolay, Elisabeth Szumilin, Suna Balkan, Elisabeth Poulet, and Mar Pujades-Rodriguez. "Adults Receiving HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa." JAIDS Journal of Acquired Immune Deficiency Syndromes 64, no. 5 (December 2013): 455–63. http://dx.doi.org/10.1097/qai.0b013e3182a61e8d.
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Ahinkorah, Bright Opoku, Richard Gyan Aboagye, Abdul-Aziz Seidu, James Boadu Frimpong, Abdul Cadri, Agani Afaya, John Elvis Hagan, and Sanni Yaya. "Prevalence and predictors of oral rehydration therapy, zinc, and other treatments for diarrhoea among children under-five in sub-Saharan Africa." PLOS ONE 17, no. 10 (October 13, 2022): e0275495. http://dx.doi.org/10.1371/journal.pone.0275495.
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Background Despite the evidence-based effectiveness of diarrhoea treatment in preventing diarrhoea-related child mortality, the accessibility and utilization of diarrhoea treatments remain low in sub-Saharan Africa, even though these treatments are available. Therefore, this study aimed to assess the prevalence and predictors of diarrhoea treatment among under-five children in sub-Saharan Africa. Methods This study involved cross-sectional analyses of secondary data from the most recent Demographic and Health Surveys of 30 countries in sub-Saharan Africa. Percentages with their respective 95% confidence intervals (CI) were used to summarise the prevalence of diarrhoea treatment. A multivariable multilevel binary logistic regression analysis was employed to examine the predictors of diarrhoea treatment among children under five years in sub-Saharan Africa. The regression results were presented using adjusted odds ratio with their accompanying 95% confidence intervals. Statistical significance was set at p<0.05. Stata software version 16.0 was used for the analyses. Results The overall prevalence of diarrhoea treatment among under-five children in sub-Saharan Africa was 49.07% (95% CI = 44.50–53.64). The prevalence of diarrhoea treatment ranged from 23.93% (95% CI = 20.92–26.94) in Zimbabwe to 66.32% (95% CI = 61.67–70.97) in Liberia. Children aged 1 to 4 years, those whose mothers had at least primary education, those whose mothers had postnatal care visits, those whose mothers believed that permission to go and get medical help for self was a big problem, and those whose mothers’ partners had at least primary education were more likely to undergo diarrhoea treatment as compared to their counterparts. The odds of diarrhoea treatment increased with increasing wealth index with the highest odds among those in the richest quintile. Also, the odds of diarrhoea treatment was higher in the Central, Eastern, and Western geographical subregions compared to those in the Southern geographical subregion. However, children whose mothers were cohabiting, those whose mothers were exposed to watching television, and those living in female-headed households were less likely to undergo diarrhoea treatment. Conclusion The study found that the prevalence of diarrhoea treatment among children in sub-Saharan Africa was relatively low and varied across countries. The sub-regional estimates of diarrhoea treatment and identified associated factors can support country-specific needs assessments targeted at improving policy makers’ understanding of within-country disparities in diarrhoea treatment. Planned interventions (e.g., provision of quality and affordable supply of oral rehydration salts and zinc) should seek to scale up diarrhoea treatment uptake among under-five children in sub-Saharan Africa with much focus on the factors identified in this study.
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Bingham, J. S. "The sins of the fathers — Africans with HIV infection in London; lessons for others?" International Journal of STD & AIDS 13, no. 1_suppl (December 2002): 42–44. http://dx.doi.org/10.1258/095646202762226164.
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Many European countries have taken in immigrants from sub-Saharan Africa. The reasons for this are discussed and the particular problems experienced by HIV-infected Africans in London, and the approach to their care at St Thomas’ Hospital, is delineated.
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Martins, Tanimola, Samuel William David Merriel, and William Hamilton. "Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review." BMJ Open 10, no. 11 (November 2020): e038605. http://dx.doi.org/10.1136/bmjopen-2020-038605.
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BackgroundMost cancers in sub-Saharan Africa (SSA) are diagnosed at advanced stages, with limited treatment options and poor outcomes. Part of this may be linked to various events occurring in patients’ journey to diagnosis. Using the model of pathways to treatment, we examined the evidence regarding the routes to cancer diagnosis in SSA.Design and settingsA systematic review of available literature was performed.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Between 30 September and 30 November 2019, seven electronic databases were searched using terms relating to SSA countries, cancer and routes to diagnosis comprising the population, exposure and outcomes, respectively. Citation lists of included studies were manually searched to identify relevant studies. Furthermore, ProQuest Dissertations & Theses Global was searched to identify appropriate grey literature on the subject.Results18 of 5083 references identified met the inclusion criteria: eight focused on breast cancer; three focused on cervical cancer; two each focused on lymphoma, Kaposi’s sarcoma and childhood cancers; and one focused on colorectal cancer. With the exception of Kaposi’s sarcoma, definitive diagnoses were made in tertiary healthcare centres, including teaching and regional hospitals. The majority of participants initially consulted within primary care, although a considerable proportion first used complementary medicine before seeking conventional medical help. The quality of included studies was a major concern, but their findings provided important insight into the pathways to cancer diagnosis in the region.ConclusionThe proportion of patients who initially use complementary medicine in their cancer journey may explain a fraction of advanced-stage diagnosis and poor survival of cancer in SSA. However, further research would be necessary to fully understand the exact role (or activities) of primary care and alternative care providers in patient cancer journeys.
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Saito, Suzue, Andrea A. Howard, Michael J. A. Reid, Batya Elul, Anna Scardigli, Sabine Verkuijl, Alaine U. Nyaruhirira, and Denis Nash. "TB Diagnostic Capacity in Sub-Saharan African HIV Care Settings." JAIDS Journal of Acquired Immune Deficiency Syndromes 61, no. 2 (October 2012): 216–20. http://dx.doi.org/10.1097/qai.0b013e3182638ec7.
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Nweke, Michael Chukwugoziem, Clement Abu Okolo, Yara Daous, and Olukemi Ayotunde Esan. "Challenges of Human Papillomavirus Infection and Associated Diseases in Low-Resource Countries." Archives of Pathology & Laboratory Medicine 142, no. 6 (June 1, 2018): 696–99. http://dx.doi.org/10.5858/arpa.2017-0565-ra.
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Context.— The prevalence of human papillomavirus (HPV) infection varies worldwide. The high-risk viruses are usually associated with cancers of the cervix, vagina, and vulva in women, cancer of the penis in men, and cancers of the anus, tonsils, oropharynx, and base of the tongue in both sexes. Objectives.— To review literature about the challenges and burden associated with HPV infection in low-resource (ie, developing) countries, focusing on sub-Saharan Africa. To review the prevention, incidence, prevalence, morbidity, and mortality of HPV infections in sub-Saharan Africa. To review the therapy and management of HPV infections in low-resource countries in comparison to developed countries. Data Sources.— Peer-reviewed literature and experience of some of the authors. Conclusions.— Sub-Saharan Africa has high HPV infection prevalence rates, with predominance of high-risk subtypes 16, 18, and 45. The difficulty of access to health care has led to higher morbidity and mortality related to HPV-related cancers. Improvement in screening programs will help in monitoring the spread of HPV infections. Survival studies can be more informative if reliable cancer registries are improved. HPV vaccination is not yet widely available and this may be the key to curtailing the spread of HPV infections in resource-poor countries.
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Chu, Lisa W., Jamie Ritchey, Susan S. Devesa, Sabah M. Quraishi, Hongmei Zhang, and Ann W. Hsing. "Prostate Cancer Incidence Rates in Africa." Prostate Cancer 2011 (2011): 1–6. http://dx.doi.org/10.1155/2011/947870.
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African American men have among the highest prostate cancer incidence rates in the world yet rates among their African counterparts are unclear. In this paper, we compared reported rates among black men of Sub-Saharan African descent using data from the International Agency for Research on Cancer (IARC) and the National Cancer Institute Surveillance, Epidemiology, and End Results Program for 1973–2007. Although population-based data in Africa are quite limited, the available data from IARC showed that rates among blacks were highest in the East (10.7–38.1 per 100,000 man-years, age-adjusted world standard) and lowest in the West (4.7–19.8). These rates were considerably lower than those of 80.0–195.3 observed among African Americans. Rates in Africa increased over time (1987–2002) and have been comparable to those for distant stage in African Americans. These patterns are likely due to differences between African and African American men in medical care access, screening, registry quality, genetic diversity, and Westernization. Incidence rates in Africa will likely continue to rise with improving economies and increasing Westernization, warranting the need for more high-quality population-based registration to monitor cancer incidence in Africa.
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Balcha, Taye T. "Establishing Health Biotech and Enhancing Local Manufacturing of Pharmaceuticals in Sub-Saharan Africa." Global Advances in Health and Medicine 7 (January 2018): 216495611880968. http://dx.doi.org/10.1177/2164956118809685.
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Although many nations in Sub-Saharan Africa (SSA) have recently recorded impressive economic growth, and several countries could attain middle-income status in the next decade, there is no or little concurrent advance in health biotech with little capabilities for manufacturing of medicines, medical supplies, and health commodities in the region. They import majority of medicines, medical supplies, and health commodities used in national programs including immunization, family planning, tuberculosis, HIV, and malaria that drive health outcomes and population-level impact with supports mainly obtained from high-income countries, multilateral agencies, or philanthropies. Nevertheless, there is a growing global debate that countries should graduate from receiving development assistance which goes to the most important health programs like immunization when nations transition from low-income to middle-income economic status. Since sudden withdrawal of all or partial development assistance could send a shock to the health care and dent the trajectory toward achieving the health Sustainable Development Goal, it is imperative to urgently establish or strengthen health biotech and enhance manufacturing of pharmaceuticals in SSA.
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Rubagumya, Fidel, Gunita Mitera, Sidy Ka, Achille Van Christ Manirakiza, Phillipa Kibugu-Decuir, Susan Citonje Msadabwe, Ablavi Ahoefa Adani-Ife, et al. "Choosing Wisely Africa: 10 low-value or harmful practices that should be avoided in cancer care." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19213-e19213. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19213.
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e19213 Background: Choosing Wisely Africa, builds on Choosing Wisely (CW) in the USA, Canada and India, and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. Methods: The CWA Task Force was convened by African Organization for Research and Training in Cancer (AORTIC) and included representatives in surgical, medical and radiation oncology, the private and public sectors and patient advocacy group. Consensus was built through a modified Delphi process shortening a long list of practices to a short list then to a final list. Results: Of the 10 practices on the final list, one is a new suggestion, 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and 1 relates to surveillance. Conclusions: The success of this campaign will be measured by how the list is implemented across sub-Saharan Africa and whether it improves the delivery of high-quality cancer care. [Table: see text]
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Decroo, Tom, Wim Van Damme, Guy Kegels, Daniel Remartinez, and Freya Rasschaert. "Are Expert Patients an Untapped Resource for ART Provision in Sub-Saharan Africa?" AIDS Research and Treatment 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/749718.
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Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS.
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Rydzak, Chara E., and Sue J. Goldie. "Cost-Effectiveness of Rapid Point-of-Care Prenatal Syphilis Screening in Sub-Saharan Africa." Sexually Transmitted Diseases 35, no. 9 (September 2008): 775–84. http://dx.doi.org/10.1097/olq.0b013e318176196d.
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Bello, Kéfilath, Jan De Lepeleire, Jeff Kabinda M., Samuel Bosongo, Jean-Paul Dossou, Evelyn Waweru, Ludwig Apers, Marcel Zannou, and Bart Criel. "The expanding movement of primary care physicians operating at the first line of healthcare delivery systems in sub-Saharan Africa: A scoping review." PLOS ONE 16, no. 10 (October 22, 2021): e0258955. http://dx.doi.org/10.1371/journal.pone.0258955.
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Introduction In sub-Saharan Africa (SSA), the physicians’ ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs’ practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare. Methods We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders. Findings We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, “médecins généralistes communautaires”, and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs’ governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs’ activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa. Conclusions This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs.
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Moon, T. D., J. R. Burlison, M. Blevins, B. E. Shepherd, A. Baptista, M. Sidat, A. E. Vergara, and S. H. Vermund. "Enrolment and programmatic trends and predictors of antiretroviral therapy initiation from President's Emergency Plan for AIDS Relief (PEPFAR)-supported public HIV care and treatment sites in rural Mozambique." International Journal of STD & AIDS 22, no. 11 (November 2011): 621–27. http://dx.doi.org/10.1258/ijsa.2011.010442.
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Summary Many countries in sub-Saharan Africa have made antiretroviral therapy (ART) available in urban settings, but the progress of treatment expansion into rural Africa has been slower. We analysed routine data for patients enrolled in a rural HIV treatment programme in Zambézia Province, Mozambique (1 June 2006 through 30 March 2009). There were 12,218 patients who were ≥15 years old enrolled (69% women). Median age was 25 years for women and 31 years for men. Older age and higher level of education were strongly predictive of ART initiation (P < 0.001). Patients with a CD4+ count of 350 cells/μL versus 50 cells/μL were less likely to begin ART (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.16-0.23). In rural sub-Saharan Africa, HIV testing, linkage to care, logistics for ART initiation and fears among some patients to take ART require specialized planning to maximize successes. Sustainability will require improved health manpower, infrastructure, stable funding, continuous drug supplies, patient record systems and, most importantly, community engagement.
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Milln, JM, and A. Nakimuli. "Medical complications in pregnancy at Mulago Hospital, Uganda’s national referral hospital." Obstetric Medicine 12, no. 4 (November 26, 2018): 168–74. http://dx.doi.org/10.1177/1753495x18805331.
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Introduction Medical complications in pregnancy contribute significantly to maternal morbidity in sub-Saharan Africa. Anecdotally, obstetricians in Uganda do not feel equipped to treat complex medical cases, and receive little support from physicians. Methods The aim of the study was to quantify the burden of complex medical conditions on the obstetric high dependency unit at Mulago National Referral Hospital, and potential deficiencies in the referral of cases and training in obstetric medicine. A prospective audit was taken on the obstetric high dependency unit from April to May 2014. In addition, 50 trainees in obstetrics and gynaecology filled a nine-point questionnaire regarding their experiences. Results Complex medical disorders of pregnancy accounted for 22/106 (21%) admissions to the high dependency unit, and these cases were responsible for 51% of total bed occupancy, and had a case fatality rate of 6/22 (27.2%). Only 6/14 (43%) of referrals to medical specialties were fulfilled within 48 h. Of the six women who died due to medical conditions, three specialty referrals were made, none of which were fulfilled. Trainees reported deficiencies in obstetric medicine training and in referral of complex conditions. They were least confident addressing non-communicable conditions in pregnancy. Discussion Deficiencies exist in the care of women with complex medical conditions in pregnancy in Uganda. Frameworks of obstetric medicine training and referral of complex cases should be explored and adapted to the sub-Saharan African setting.
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Agan, Brian K., and Vincent C. Marconi. "Noncommunicable Diseases: Yet Another Challenge for Human Immunodeficiency Virus Treatment and Care in Sub-Saharan Africa." Clinical Infectious Diseases 71, no. 8 (November 17, 2019): 1874–76. http://dx.doi.org/10.1093/cid/ciz1104.
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Kasper, Jennifer, and Francis Bajunirwe. "Brain drain in sub-Saharan Africa: contributing factors, potential remedies and the role of academic medical centres." Archives of Disease in Childhood 97, no. 11 (September 8, 2012): 973–79. http://dx.doi.org/10.1136/archdischild-2012-301900.
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A double jeopardy exists in resource-limited settings (RLS) in sub-Saharan Africa (SSA): there are a disproportionately greater number of acutely ill patients, but a paucity of healthcare workers (HCW) to care for them. SSA has 25% of the global disease burden but only 3% of the world's HCW. Thirty-two SSA countries do not meet the WHO minimum of 23 HCW per 10000 population. Contributing factors include insufficient supply, inadequate distribution and migration. Potential remedies include international workforce policies, non-governmental organisations, national and international medical organisations’ codes of conduct, inter-country collaborations, donor-directed policies and funding to train more people in-country, and health system strengthening and task-shifting. Collaborations among academic institutions from resource-rich and poor countries can help address HCW supply, distribution and migration. It is now opportune to harness bright, committed people from academic centres in resource-rich and poor settings to create long-term, collaborative relationships focused on training, clinical skills and locally relevant research endeavours, who mutually strive for HCW retention, less migration, and ultimately sufficient HCW to provide optimal care in all RLS.
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Weisser, Maja, Martin Rohacek, Robert Ndege, Ezekiel Luoga, Andrew Katende, Getrud J. Mollel, Winfrid Gingo, et al. "The Chronic Diseases Clinic of Ifakara (CDCI)—Establishing a Model Clinic for Chronic Care Delivery in Rural Sub-Saharan Africa." Diseases 10, no. 4 (September 30, 2022): 72. http://dx.doi.org/10.3390/diseases10040072.
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The rollout of antiretroviral drugs in sub-Saharan Africa to address the huge health impact of the HIV pandemic has been one of the largest projects undertaken in medical history and is an unprecedented medical success story. However, the path has been and still is characterized by many far reaching implementational challenges. Here, we report on the building and maintaining of a role model clinic in Ifakara, rural Southwestern Tanzania, within a collaborative project to support HIV services within the national program, training for staff and integrated research to better understand local needs and improve patients’ outcomes.
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El-Houderi, Amira, Joëlle Constantin, Emanuela Castelnuovo, and Christophe Sauboin. "Economic and Resource Use Associated With Management of Malaria in Children Aged <5 Years in Sub-Saharan Africa: A Systematic Literature Review." MDM Policy & Practice 4, no. 2 (July 2019): 238146831989398. http://dx.doi.org/10.1177/2381468319893986.
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Background. Malaria is a major health, economic, and social burden in sub-Saharan Africa. Purpose. The objective is to help understanding the economic impact of malaria and informing estimates of the potential economic impact of malaria prevention. To achieve this, we conducted a systematic review of published information on health system costs, health care resource use, and household costs for the management of malaria episodes in children aged <5 years in sub-Saharan Africa. Data Sources and Study Selection. We conducted searches in Medline, EMBASE, and Cochrane Library for studies reporting data on economic cost or resource use associated with management of malaria in children aged <5 years in sub-Saharan Africa. Searches were limited to articles published in English or French between January 1, 2006, and September 1, 2016. Conference abstracts from 2014 to 2016 were hand-searched. Data Extraction and Data Synthesis. We identified 1846 publications, of which 17 met the selection criteria. The studies covered nine countries: The Democratic Republic of Congo, Ghana, Kenya, Malawi, Mozambique, Nigeria, Tanzania, Uganda, and Zambia. All costs were standardized to 2016 US dollars (US$). Seven studies estimated the costs of a malaria episode to health systems, and 10 publications plus one abstract reported household costs. The cost to the health system was US$1.94 to US$31.53 for outpatient malaria cases to US$20 to US$136 for inpatient cases. Families bear a large share of the burden through out-of-pocket payments of medical care and lost income due to time off work. Limitations. Data were missing for many countries and few comparisons could be made. Conclusions. Severe malaria is associated with much higher costs than uncomplicated malaria, and families bear a large share of the cost burden.
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Mutisya, David Nzioka. "Predictors of HIV Infection Risk among Health-Care Workers in Sub-Saharan Africa: A Systematic Review." African Journal of Empirical Research 2, no. 2 (November 19, 2021): 176–91. http://dx.doi.org/10.51867/ajer.v2i2.45.
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The study set out to investigate the determinants of HIV infection risk among healthcare workers in SSA through a systematic review. The aim of the study was to identify, collect and systematically review and synthesize existing literature articles on the determinants of HIV infection risk among healthcare workers in SSA. The objectives of the study were to: determine the prevalence of health care workers' exposure to HIV risky conditions in health care settings in SSA; identify selected determinants of HIV infection risk among Health care workers in SSA (major focus in Nigeria, South Africa, and Tanzania) and apply effective strategies to prevent issues associated with HIV infection risk among Health care workers. The study conceptualizes that HCWs in the SSA region are at risk of HIV infection due to factors related to lack of healthcare resources, their knowledge, attitude and practice, and barriers to reporting. The combined effect of these factors is that hoped to determine the propensity of HCWs to be infected by HIV/AIDS. The key themes guiding the systematic review were: risk to exposure to HIV among HCWs; lack of health care resources and facilities. The findings of the study confirmed all the three alternative study hypotheses that: there is a significant relationship between lack of health care resources and facilities and the risk of HIV infection among HCWs in SSA; there is a significant relationship between HCWs’ knowledge, attitude, and practice on HIV and their risk of HIV infection in SSA and; there is a significant relationship between barriers to reporting and the risk of HIV infection among HCWs in SSA. In this regard, the study found out that HCWs in SSA are at high risk of HIV exposure whilst working. In this regard, this is a result of lack of enough equipment, poor practices at work and barriers to reporting, including stigmatization and lack of well-stipulated reporting guidelines. As such, the following recommendations were made:: there is a need to increase funding in the health care sector to enhance access to the right equipment, microbicides, vaccination, and PEP for HCWs; there is a need for psychosocial support systems to make it easy for HCWs to report infection with ease and that; the government should adopt recommended global best standards to enhance protection of HCWs while at work in SSA. Two areas for further study were also recommended. As such, there is a need for studies on each of the study objectives, and; there is a need for a descriptive study on the topic under investigation in this study for correlation purposes.
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Kuate, Marius Paulin Ngouanom, Bassey Ewa Ekeng, Richard Kwizera, Christine Mandengue, and Felix Bongomin. "Histoplasmosis overlapping with HIV and tuberculosis in sub-Saharan Africa: challenges and research priorities." Therapeutic Advances in Infectious Disease 8 (January 2021): 204993612110086. http://dx.doi.org/10.1177/20499361211008675.
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Histoplasmosis, tuberculosis and HIV are all highly prevalent in sub-Saharan Africa (SSA). Co-occurrence of two or more of these infections has been reported in several populations of patients, especially those with advanced HIV infection where these opportunistic infections contribute to a significant morbidity and mortality. With a high burden of pulmonary tuberculosis (PTB) secondary to HIV in SSA, histoplasmosis is commonly misdiagnosed as smear-negative PTB in HIV patients due to similar clinical and radiological presentations. This is also partly the result of the lack of trained clinical and laboratory personnel to make a definite diagnosis of histoplasmosis. There is a low index of clinical suspicion for histoplasmosis, and cases are mostly discovered accidently and documented through case reports and case series. Similarly, the high cost and lack of fungal diagnostics in most SSA countries makes it difficult to make a diagnosis. There is a need to build local capacity for mycology so that patients are managed to improve on the index of clinical suspicion and diagnostic capabilities. Moreover, simple accurate point-of-care diagnostic tests and first-line antifungal treatment for histoplasmosis are not available in many SSA countries. This review describes the existence of co-infections of histoplasmosis, tuberculosis and HIV in SSA, highlighting the challenges and research priorities.
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Beattie, Pauline, and Moses Bockarie. "THE NINTH FORUM OF THE EUROPEAN & DEVELOPING COUNTRIES CLINICAL TRIALS PARTNERSHIP." BMJ Global Health 4, Suppl 3 (April 2019): A1. http://dx.doi.org/10.1136/bmjgh-2019-edc.1.
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The EDCTP community meets biennially to share research findings, plan new partnerships and collaborations, and discuss maximising impact from EDCTP-funded research. In 2018, the Ninth EDCTP Forum took place in Lisbon, Portugal, from 17–21 September 2018. The Lisbon meeting was the largest international conference focusing on clinical research on poverty-related infectious diseases in sub-Saharan Africa. It started with a strong commitment, from European and African EDCTP member countries, for a successor programme to EDCTP2 (2014–2024). It provided a platform for the presentation of project results and discussion of progress in clinical research and capacity strengthening in sub-Saharan Africa.The theme of the Ninth Forum was ‘Clinical research and sustainable development in sub-Saharan Africa: the impact of North-South partnerships’. This reflected not only the broader scope of a larger EDCTP research programme but also the growing awareness of the need for global cooperation to prepare for public health emergencies and strengthen health systems. The theme highlighted the impact of Europe-Africa partnerships supporting clinical research and the clinical research environment, towards achieving the sustainable development goals in sub-Saharan Africa.A central topic of the Forum was the discussion of the character and scope of an EDCTP successor programme, which should start in 2021 under the next European Framework Programme for Research and Innovation, Horizon Europe. On 17 September, a high-level meeting on this topic took place immediately before the opening of the Forum1. On 19 September, the plenary session continued this discussion through a panel of representatives of strategic partners. There was consensus on the added value of the programme for Europe and the countries in sub-Saharan Africa and political commitment to a successor programme. Poverty-related infectious diseases and a partnership approach will remain central to the programme. There was also a general awareness that all participating countries would need to engage more strongly with a successor programme, both in its governance and in their financial contributions to its objectives.The Forum hosted 550 participants from more than 50countries. The programme consisted of keynote addresses by policy makers, research leaders, and prominent speakers from Europe and Africa in 5 plenary presentations. There were 9 symposia, 45 oral presentations in parallel sessions, and 74 electronic poster presentations. Abstracts of the plenary, oral and poster presentations are published in this supplement to BMJ Global Health.EDCTP is proud of its contribution to strengthening clinical research capacity in Africa, with more than 400 postgraduate students and 56 EDCTP fellows supported under the first EDCTP programme. The second programme developed a comprehensive fellowship scheme. More than 100 EDCTP fellows (former and current) participated in a one-day pre-conference to discuss the further development of our Alumni Network launched in 2017. The Forum also offered scholarships to many early and mid-career researchers from sub-Saharan Africa and Europe. With the support of the European Union, EDCTP member countries and sponsors, they were able to present results of their studies and meet colleagues from Africa and Europe.The Forum also provided the appropriate platform for recognising individual and team achievements through the four EDCTP 2018 Prizes. With the support of the European Union, EDCTP recognised outstanding individuals and research teams from Africa and Europe. In addition to their scientific excellence, the awardees made major contributions to the EDCTP objectives of clinical research capacity development in Africa and establishing research networks between North and South as well as within sub-Saharan Africa.Dr Pascoal Mocumbi Prize Professor Souleyman Mboup (Professor of Microbiology, University of Cheikh Anta Diop, Dakar; Head of the Bacteriology-Virology Laboratory of CHU Le Dantec, Dakar; and President of IRESSEF, Senegal) was recognised for his outstanding achievements in advancing health research and capacity development in Africa.Outstanding Research Team Prize The prize was awarded to the team of the CHAPAS (Children with HIV in Africa – Pharmacokinetics and acceptability of simple antiretroviral regimens) studies, led by Professor Diana Gibb (MRC Clinical Trials Unit, United Kingdom).Outstanding Female Scientist Prize The prize was awarded to Professor Gita Ramjee (Chief Specialist Scientist and Director of the HIV Prevention Research Unit of the South African Medical Research Council, Durban, South Africa) for her outstanding contributions to her field.Scientific Leadership Prize The prize was awarded to Professor Keertan Dheda (Head of the Centre for Lung Infection and Immunity and Head of the Division of Pulmonology at Groote Schuur Hospital and the University of Cape Town, South Africa) for his research contributions and leadership.Partnership is at the core of the EDCTP mission. In the year before the Forum, Nigeria and Ethiopia were welcomed as the newest member countries of the EDCTP Association, while Angola became an aspirant member. Partnership was also demonstrated by the many stakeholders who enriched the programme by organising scientific symposia, collaborative sessions and workshops. We thank our sponsors Novartis, Merck, the European Union, the Federal Ministry of Education and Research (Germany), the Institute of Health Carlos III (Spain), the National Alliance for Life Sciences and Health (France), the Medical Research Council (United Kingdom), the Swedish International Development Agency (Sweden), ClinaPharm (African CRO), the Deutsche Stiftung Weltbevölkerung (Germany), The Global Health Network (United Kingdom), PATH, and ScreenTB. We gratefully acknowledge the support of our partners and hosts of the Forum, the Portuguese Foundation for Science and Technology and the Calouste Gulbenkian Foundation.The tenth EDCTP Forum will take place in sub-Saharan Africa in 2020.
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Winstanley, Peter, Stephen Ward, Robert Snow, and Alasdair Breckenridge. "Therapy of Falciparum Malaria in Sub-Saharan Africa: from Molecule to Policy." Clinical Microbiology Reviews 17, no. 3 (July 2004): 612–37. http://dx.doi.org/10.1128/cmr.17.3.612-637.2004.
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SUMMARY The burden of falciparum malaria remains as great as ever, and, as has probably always been the case, it is carried mainly by tropical Africa. Of the various means available for the control of malaria, the use of effective drugs remains the most important and is likely to remain so for a considerable time to come. Unfortunately, the extensive development of resistance by the parasite threatens the utility of most of the affordable classes of drug: the development of novel antimalarials has never been more urgently needed. Any attempt to understand the vast complexities of falciparum malaria in Africa requires an ability to think “from molecule to policy.” In consequence, the review ambitiously tries to examine the current pharmacopeia, the process by which new drugs are developed and the ways in which drugs are actually used, in both the formal and informal health sectors. The informal sector is particularly important in Africa, where around half of all antimalarial treatments are bought from informal outlets and taken at home without supervision by health care professionals: the potential impact of adherence on clinical outcome is discussed. Given that the full costs are carried by the patient in a large proportion of cases, the importance of drug affordability is explored. The review also discusses the splicing of new drugs into national policy. The various parameters that feed into deliberations on changes in drug policy are discussed.
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Arhin, Kwadwo, and Albert Opoku Frimpong. "Assessing the Efficiency of Public Health and Medical Care Services in Curbing the COVID-19 Pandemic in Sub-Saharan Africa: A Retrospective Study." Global Journal of Health Science 14, no. 4 (March 30, 2022): 111. http://dx.doi.org/10.5539/gjhs.v14n4p111.
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In the late of December 2019, a new coronavirus (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) emerged from the city of Wuhan, China and was subsequently declared a pandemic by the World Health Organization (WHO) on March 11, 2020 after it had spread to many countries across the globe. On February 28, 2020, the Sub-Saharan Africa (SSA) reported its first case in Nigeria, and it has since spread to all countries in SSA. Several public health and medical care measures were rolled out by many countries to stem the tide of the spread at the height of the pandemic, between February 28, 2020 and February 28, 2021, period covered by this study. This paper evaluates the levels of health system efficiency of the COVID-19 public health measures and medical care services and their determinants across Sub-Saharan African (SSA) countries using country-level data for those countries. The data was analyzed using bootstrap data envelopment analysis (DEA) and other advanced econometric analyses that produce robust estimations of the relationship between health systems efficiency and their determinants. The general finding of the study suggests that there is more room for health systems in SSA to improve their technical efficiency in fighting the COVID-19 pandemic. The most important determinants of health system efficiency in the fight against the spread of the virus were GDP per capita, population density, temperature levels, and quality of governance. Adequate health system preparedness and human resource strategies geared towards recruiting and/or retaining well-qualified and experienced healthcare workers to provide professional services would prove critical in containing pandemics of this nature.
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Sokunbi, Ogochukwu J., Ogadinma Mgbajah, Augustine Olugbemi, Bassey O. Udom, Ariyo Idowu, and Michael O. Sanusi. "Maintaining paediatric cardiac services during the COVID-19 pandemic in a developing country in sub-Saharan Africa: guidelines for a “scale up” in the face of a global “scale down”." Cardiology in the Young 30, no. 11 (November 2020): 1588–94. http://dx.doi.org/10.1017/s1047951120003650.
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AbstractThe COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care.There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.
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Kotwica, Aleksandra, Peter Shija, Tom Hampton, and David Howard. "The introduction of a paediatric ENT and anaesthesia skills course in Kilimanjaro Christian Medical Centre hospital, (KCMC), Moshi, Tanzania." Tropical Doctor 51, no. 3 (May 21, 2021): 375–78. http://dx.doi.org/10.1177/00494755211016612.
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Human factors and a safe operating theatre environment are of paramount importance, wherever surgery is undertaken. The majority of patients in sub-Saharan Africa do not yet have access to safe surgery. The Paediatric ENT Skills and Airway Course introduced and evaluated here was designed to improve outcomes and safety in a typical East African environment. The lectures, tutorials and practicals covered technical and non-technical skills. Responses from pre- and post-course questionnaires were evaluated as an initial surrogate for effectiveness of this course. The latter showed improvement in all taught skills and found universal recommendation. The course had been established to try to minimise morbidity and mortality after paediatric surgery at our institution, KCMC. We encouraged team co-operation in the care of patients, and recommend other centres consider similar courses building on human factors for safer operating theatre working practices.
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Wariri, Oghenebrume, Uduak Okomo, Carla Cerami, Emmanuel Okoh, Francis Oko, Hawanatu Jah, Kalifa Bojang, et al. "Establishing and operating a ‘virtual ward’ system to provide care for patients with COVID-19 at home: experience from The Gambia." BMJ Global Health 6, no. 6 (June 2021): e005883. http://dx.doi.org/10.1136/bmjgh-2021-005883.
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Health systems in sub-Saharan Africa have remained overstretched from dealing with endemic diseases, which limit their capacity to absorb additional stress from new and emerging infectious diseases. Against this backdrop, the rapidly evolving COVID-19 pandemic presented an additional challenge of insufficient hospital beds and human resource for health needed to deliver hospital-based COVID-19 care. Emerging evidence from high-income countries suggests that a ‘virtual ward’ (VW) system can provide adequate home-based care for selected patients with COVID-19, thereby reducing the need for admissions and mitigate additional stress on hospital beds. We established a VW at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, a biomedical research institution located in The Gambia, a low-income west African country, to care for members of staff and their families infected with COVID-19. In this practice paper, we share our experience focusing on the key components of the system, how it was set up and successfully operated to support patients with COVID-19 in non-hospital settings. We describe the composition of the multidisciplinary team operating the VW, how we developed clinical standard operating procedures, how clinical oversight is provided and the use of teleconsultation and data capture systems to successfully drive the process. We demonstrate that using a VW to provide an additional level of support for patients with COVID-19 at home is feasible in a low-income country in sub-Saharan Africa. We believe that other low-income or resource-constrained settings can adopt and contextualise the processes described in this practice paper to provide additional support for patients with COVID-19 in non-hospital settings.
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Taniguchi, Cullen M., Anuja Jhingran, Shane Richard Stecklein, Adam Melancon, Laurence Court, Jared Ohrt, Michael Elliot Kupferman, and Susan Citonje Msadabwe. "A pilot course of intensive training in radiation biology and physics for oncologists in sub-Saharan Africa." Journal of Global Oncology 5, suppl (October 7, 2019): 24. http://dx.doi.org/10.1200/jgo.2019.5.suppl.24.
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24 Background: Radiation therapy is an essential component of cancer care used for palliative and curative treatments access a wide spectrum of disease, but many low- and middle-income countries do not have equitable access to this technology or training in the radiation sciences. Towards this end, we launched a pilot program to teach the principles of radiation biology and radiation physics that are a basic component of training and credentialing of radiation oncologists in the United States. Methods: We designed a 5 days curriculum for radiation biology and radiation physics that were similar in depth and scope to the courses taught to residents at MD Anderson. Medical oncologists, medical students and radiation therapists from Zambia, Tanzania, Lesotho, as well as Papua New Guinea attended the course. All have experience with direct patient care in oncology, but no formal training in radiation biology or physics. A pre-test of 50 multiple choice questions for radiation biology and 40 multiple choice questions for radiation physics was administered to all students prior any instruction on the first day of the course, and the same test was given on the last day. Each question stem had 4 possible choices. Instructions consisted of lectures and problems sets with an emphasis on practical applications of radiation biology and physics. Results: The students (N = 22) scored a mean of 30.6±13.5% correct on the radiation biology pre-test and this improved to a mean of 57.7±13.1% after 5 days of instruction (P < 0.0001). Similarly, the students who took the medical physics exam (N = 22) had a mean 33.0±8.8% correct at baseline, which improved to 61.7±18.1% on the post-test (P < 0.0001). Conclusions: Despite almost no prior exposure to these complicated concepts, students exhibited nearly a two-fold increase in scores on a standardized test of radiation biology and medical physics. This pilot study demonstrates a proof-of-concept that this material can be taught effectively in a short time frame. Further refinement of this material may allow similar in-person intensive courses, teleconferencing, or archived videos to improve the education of radiation therapists in low- and middle-income countries.
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Fayorsey, Ruby N., Suzue Saito, Rosalind J. Carter, Eduarda Gusmao, Koen Frederix, Emily Koech-Keter, Gilbert Tene, Milembe Panya, and Elaine J. Abrams. "Decentralization of Pediatric HIV Care and Treatment in Five Sub-Saharan African Countries." JAIDS Journal of Acquired Immune Deficiency Syndromes 62, no. 5 (April 2013): e124-e130. http://dx.doi.org/10.1097/qai.0b013e3182869558.
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Masigati, Herbert G., Grant W. Potter, Masahiro J. Morikawa, and Rashid S. Mfaume. "Strengthening district healthcare in rural Africa: a cross-sectional survey assessing difficulties in pulse oximetry use and handoff practices." International Journal Of Community Medicine And Public Health 6, no. 1 (December 24, 2018): 57. http://dx.doi.org/10.18203/2394-6040.ijcmph20185227.
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Background: Rural hospitals in sub-Saharan Africa suffer from numerous disparities in resources and practices, and subsequently patient care is affected.Methods: In order to assess current practices and opportunities for improvement in pulse oximetry use and patient-care handoffs, a cross-sectional survey was administered to clinicians at a referral level hospital serving a large rural area in Shinyanga, Tanzania.Results: Respondents (n=46) included nurses (50%), medical doctors (48%), and clinical officers (2%). A response rate of 92% was achieved, and 81% of clinicians acknowledged routine difficulties in the use of current devices when obtaining pulse oximetry. Although 83% of respondents reported using a written handoff at shift change, information reporting was inconsistent and rarely included specific management guidance.Conclusions: Further research is needed to elucidate handoff practices in developing settings, but there is a large opportunity for novel point-of-care devices and tools to improve both pulse oximetry use and patient care handoffs in rural Africa.
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Sarfo, Bismark, Naa Ashiley Vanderpuye, Abigail Addison, and Peter Nyasulu. "HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana." AIDS Research and Treatment 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/4697473.
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Background. Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4) counts among HIV patients attending ART clinic in Ghana. Methodology. This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software. Results. Of the 201 patients who participated in the study, 67% (129/191) received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR) (95% confidence interval (CI)) (2.79 (1.17–6.68)), mental health services (0.2 (0.04–1.00)), and case management support service (2.80 (1.34–5.82))) was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01–5.49)). Conclusion. Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.