scholarly journals Factors and outcomes related to the use of guideline-recommended antibiotics in patients with neutropenic fever at the Uganda Cancer Institute

2021 ◽  
Author(s):  
Elizabeth A Gulleen ◽  
Scott V Adams ◽  
Bickey Chang ◽  
Lauren Falk ◽  
Riley Hazard ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Chart Review ◽  
Case Fatality ◽  
Retrospective Chart Review ◽  
Neutropenic Fever ◽  
Sub Saharan Africa ◽  
Antibiotic Management ◽  
Delayed Initiation ◽  
Sub Saharan ◽  
Selection Of

Abstract Background Neutropenic fever (NF) is associated with significant morbidity and mortality for patients receiving cancer treatment in sub-Saharan Africa (sSA). However, the antibiotic management of NF in sSA has not been well described. We evaluated the timing and selection of antibiotics for patients with NF at the Uganda Cancer Institute (UCI). Methods We conducted a retrospective chart review of adults with acute leukemia admitted to UCI from January 1, 2016, to May 31, 2017, who developed NF. For each NF event, we evaluated the association of clinical presentation and demographics with antibiotic selection as well as time to both initial and guideline-recommended antibiotics. We also evaluated the association between ordered antibiotics and the in-hospital case fatality ratio (CFR). Results Forty-nine NF events occurred among 39 patients. The time to initial antibiotic order was <1 day. Guideline-recommended antibiotics were ordered for 37 (75%) NF events. The median time to guideline-recommended antibiotics was 3 days. Fever at admission, a documented physical examination, and abdominal abnormalities were associated with a shorter time to initial and guideline-recommended antibiotics. The in-hospital CFR was 43%. There was no difference in in-hospital mortality when guideline-recommended antibiotics were ordered as compared to when non-guideline or no antibiotics were ordered. (HR: 0.51, 95%CI: [0.10, 2.64] and 0.78, 95%CI: [0.20, 2.96], respectively). Conclusions Patients with acute leukemia and NF had delayed initiation of guideline-recommended antibiotics and a high CFR. Prospective studies are needed to determine optimal NF management in sSA, including choice of antibiotics and timing of antibiotic initiation.

scholarly journals The seasonality of cholera in sub-Saharan Africa

2021 ◽  
Author(s):  
Javier Perez-Saez ◽  
Justin Lessler ◽  
Elizabeth C. Lee ◽  
Francisco J. Luquero ◽  
Espoir B. Malembaka ◽  
...  
Keyword(s):  
Large Scale ◽  
Task Force ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Health Concern ◽  
National Differences ◽  
Sub Saharan ◽  
Eastern And Southern Africa ◽  
Positive Correlations ◽  
Gates Foundation

Background Cholera remains a major threat in Sub-Saharan Africa (SSA) where some of the highest case fatality risks are reported. Knowing in what months and where cholera tends to occur across the continent can aid in improving efforts to eliminate cholera as a public health concern; though largely due to lack of unified large-scale datasets, no continent-wide estimates exist. In this study we aim to estimate cholera seasonality across SSA. Methods We leverage the Global Task Force on Cholera Control (GTFCC) global cholera database with statistical models to synthesize data across spatial and temporal scale in order to infer the seasonality of excess suspected cholera occurrence in SSA. We developed a Bayesian statistical model to infer the monthly risk of excess cholera at the first and/or second administrative levels. Seasonality patterns were then grouped into spatial clusters. Finally, we studied the association between seasonality estimates and hydro-climatic variables. Findings The majority of studied countries (24/34) have seasonal patterns in excess cholera, corresponding to approximately 85% of the SSA population. Most countries (19/24) also had sub-national differences in seasonality patterns, with strong differences in seasonality strength between regions. Seasonality patterns clustered into two macro-regions (West Africa and the Sahel vs. Eastern and Southern Africa), which were composed of sub-regional clusters with varying degrees of seasonality. Exploratory association analysis found most consistent and positive correlations between cholera seasonality and precipitation, and to a lesser extent with temperature and flooding. Interpretation Widespread cholera seasonality in SSA offers opportunities for intervention planning. Further studies are needed to study the association between cholera and climate. Funding The NASA Applied Sciences Program and the Bill and Melinda Gates Foundation.

scholarly journals Cohort profile: internal migration in sub-Saharan Africa—The Migration and Health in Malawi (MHM) study

BMJ Open ◽  
2017 ◽  
Vol 7 (5) ◽  
pp. e014799 ◽  
Author(s):  
Philip Anglewicz ◽  
Mark VanLandingham ◽  
Lucinda Manda-Taylor ◽  
Hans-Peter Kohler
Keyword(s):  
Health Outcomes ◽  
Reference Group ◽  
Sub Saharan Africa ◽  
Extensive Information ◽  
Sub Saharan ◽  
The Relationship ◽  
Mental And Physical Health ◽  
Use Of Health Services ◽  
Migration And Health ◽  
Selection Of

PurposeThe Migration and Health in Malawi (MHM) study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is complicated by methodological challenges. The MHM study uses a longitudinal panel premigration and postmigration study design (with a non-migrant comparison group) to measure and/or control for important characteristics that affect both migration and health outcomes.ParticipantsData are available for two waves. The MHM interviewed 398 of 715 migrants in 2007 (55.7%) and 722 of 1013 in 2013 (71.3%); as well as 604 of 751 (80.4%) for a non-migrant reference group in 2013. The total interviewed sample size for the MHM in both waves is 1809. These data include extensive information on lifetime migration, socioeconomic and demographic characteristics, sexual behaviours, marriage, household/family structure, social networks and social capital, HIV/AIDS biomarkers and other dimensions of health.Findings to dateOur result for the relationship between migration and health differs by health measure and analytic approach. Migrants in Malawi have a significantly higher HIV prevalence than non-migrants, which is primarily due to the selection of HIV-positive individuals into migration. We find evidence for health selection; physically healthier men and women are more likely to move, partly because migration selects younger individuals. However, we do not find differences in physical or mental health between migrants and non-migrants after moving.Future plansWe are preparing a third round of data collection for these (and any new) migrants, which will take place in 2018. This cohort will be used to examine the effect of migration on various health measures and behaviours, including general mental and physical health, smoking and alcohol use, access to and use of health services and use of antiretroviral therapy.

Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry

2019 ◽  
Vol 15 (6) ◽  
pp. 666-667 ◽  
Author(s):  
F Abass Cisse ◽  
C Damien ◽  
M Haba ◽  
ML Touré ◽  
M Barry ◽  
...  
Keyword(s):  
Case Fatality ◽  
Sub Saharan Africa ◽  
Stroke Registry ◽  
Stroke Prevalence ◽  
Sub Saharan

Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.

Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa

AIDS ◽  
2001 ◽  
Vol 15 (2) ◽  
pp. 143-152 ◽  
Author(s):  
Ya Diul Mukadi ◽  
Dermot Maher ◽  
Anthony Harries
Keyword(s):  
Case Fatality ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Tuberculosis Case ◽  
Sub Saharan

scholarly journals COVID-19 Mortality in Women and Men in Sub-Saharan Africa: A Cross Sectional Study

2021 ◽  
Author(s):  
Jyoti Dalal ◽  
Isotta Triulzi ◽  
Ananthu James ◽  
Benedict Nguimbis ◽  
Gabriela Guizzo Dri ◽  
...  
Keyword(s):  
Public Health ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Age Group ◽  
Sectional Study ◽  
Public Health Response ◽  
Cross Sectional ◽  
Credible Intervals ◽  
Sub Saharan

Objective: To investigate differences of COVID-19 related mortality among women and men across sub-Saharan Africa (SSA) from the beginning of the pandemic. Design: A cross sectional study. Setting: Data from 20 member nations of the WHO African region until September 1, 2020. Participants: 69,580 cases of COVID-19, stratified by sex (men, n=43071; women, n=26509) and age (0-39 years, n=41682; 40-59 years, n=20757; 60+ years, n=7141). Main outcome measures: We computed the SSA- and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach. Results: A total of 1,656 (2.4% of total cases reported; 1656/69580) deaths were reported, with men accounting for 1168/1656 (70.5%) of total deaths. In SSA, women had a lower CFR than men (mean CFR<diff> = -0.9%; 95% credible intervals -1.1% to -0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 or more (40-59 age-group: mean CFR<diff> = -0.7%; 95% credible intervals -1.1% to -0.2%; 60+ age-group: mean CFR<diff> = -3.9%; 95% credible intervals -5.3% to -2.4%). At the country level, seven of the twenty SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ age-group in seven countries and 40-59 age-group in one country. Conclusions: Sex and age are important predictors of COVID-19 mortality. Countries should prioritize the collection and use of sex-disaggregated data to understand the evolution of the pandemic. This is essential to design public health interventions and ensure that policies promote a gender sensitive public health response.

scholarly journals Differentiation in Access to, and the Use and Sharing of (Open) Educational Resources among Students and Lecturers at Technical and Comprehensive Ghanaian Universities

Open Praxis ◽  
2018 ◽  
Vol 10 (4) ◽  
pp. 405 ◽  
Author(s):  
Judith Pete ◽  
Fred Mulder ◽  
Jose Dutra Oliveira Neto ◽  
Kathleen Ludewig Omollo
Keyword(s):  
South Africa ◽  
Empirical Data ◽  
Large Scale ◽  
Open Educational Resources ◽  
Educational Resources ◽  
Sub Saharan Africa ◽  
Common Goal ◽  
Comprehensive Universities ◽  
Sub Saharan ◽  
Selection Of

This paper is the second in a series of three with a common goal to present a fair OER picture for Sub-Saharan Africa, represented by large-scale studies in three countries: Kenya, Ghana, and South Africa. This paper examines a deliberate selection of four Ghanaian universities with randomly sampled students and lecturers. Distinct questionnaires for students and the lecturers have been used, which generated a response from in total 818 students and 38 lecturers. The major outcomes based on the empirical data are: (i) there is a significant digital differentiation among lecturers and students at technical versus comprehensive universities in terms of their proficiency and internet accessibility; and (ii) the awareness and appreciation of the OER concept and open licensing is low but from the actual variety and types of processing by respondents of educational resources (not necessarily open) there is a preparedness for openness for the future.

scholarly journals Sub-Saharan Africa preparedness and response to the COVID-19 pandemic: A perspective of early career African scientists

2020 ◽  
Vol 5 ◽  
pp. 163
Author(s):  
Gisele Umviligihozo ◽  
Lucy Mupfumi ◽  
Nelson Sonela ◽  
Delon Naicker ◽  
Ekwaro A. Obuku ◽  
...  
Keyword(s):  
Public Health ◽  
Case Fatality ◽  
Early Career ◽  
Health Interventions ◽  
Sub Saharan Africa ◽  
Public Health Interventions ◽  
African Countries ◽  
Scientific Publications ◽  
First Case ◽  
Sub Saharan

Emerging highly transmissible viral infections such as SARS-CoV-2 pose a significant global threat to human health and the economy. Since its first appearance in December 2019 in the city of Wuhan, Hubei province, China, SARS-CoV-2 infection has quickly spread across the globe, with the first case reported on the African continent, in Egypt on February 14th, 2020. Although the global number of COVID-19 infections has increased exponentially since the beginning of the pandemic, the number of new infections and deaths recorded in African countries have been relatively modest, suggesting slower transmission dynamics of the virus on the continent, a lower case fatality rate, or simply a lack of testing or reliable data. Notably, there is no significant increase in unexplained pneumonias or deaths on the continent which could possibly indicate the effectiveness of interventions introduced by several African governments. However, there has not yet been a comprehensive assessment of sub-Saharan Africa’s (SSA) preparedness and response to the COVID-19 pandemic that may have contributed to prevent an uncontrolled outbreak so far. As a group of early career scientists and the next generation of African scientific leaders with experience of working in medical and diverse health research fields in both SSA and resource-rich countries, we present a unique perspective on the current public health interventions to fight COVID-19 in Africa. Our perspective is based on extensive review of the available scientific publications, official technical reports and announcements released by governmental and non-governmental health organizations as well as from our personal experiences as workers on the COVID-19 battlefield in SSA. We documented public health interventions implemented in seven SSA countries including Uganda, Kenya, Rwanda, Cameroon, Zambia, South Africa and Botswana, the existing gaps and the important components of disease control that may strengthen SSA response to future outbreaks.

scholarly journals An Overview of Cholera Epidemiology: A Focus on Africa; with a Keen Interest on Nigeria

2020 ◽  
pp. 1-17
Author(s):  
Tarh, Jacqueline Ebob
Keyword(s):  
Local Government ◽  
Task Force ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Polluted Water ◽  
The People ◽  
Sanitation And Hygiene ◽  
The World ◽  
Sub Saharan ◽  
Sanitary Conditions

Cholera is still a problem in the world today. A huge population of deaths due to cholera disease still occur in Sub-Saharan Africa (Nigeria most especially), Asia, the Americas and other developing countries, where approximately 1.7 billion inhabitants are still served by faecally polluted water sources. Approximately, 2.4 billion inhabitants of these areas of the world lack the majorly required sanitary conditions of living. Legros, asserts that, as of 2019, about forty-seven countries of the globe, are still affected by cholera. Raw or undercooked, contaminated seafood, serves as a vehicle for the transmission (especially to non-endemic areas). A Case Fatality Rate of 4.87% was recorded from 34 Local Government Areas of Bauchi, Borno, Kaduna, Kano and Zamfara state in Nigeria by the 34th week, in 2018, while 298 confirmed cases and 38 deaths (CFR 1.5%) were recorded from three Local Government Areas in two States (Adamawa & Borno) by Epidemiological week 41 in 2019. Cholera in some cases is regarded as a “disease of the poor” because the populations most affected are those that cannot afford to provide the basic health facilities for themselves. For example, waste management systems, and good accommodation with toilet facilities (the living and health conditions of the people) are wanting. In 2017, A Global Roadmap to 2030 was launched by the Global Task Force on Cholera Control (GTFCC Ending Cholera) to decrease the death rate due to cholera by 90%. By so doing, the disease can be eradicated from at least half of the 47 cholera-affected countries. The objectives of this roadmap are: to fortify health systems, water, sanitation and hygiene (WASH), and to coordinate different ways by which cholera can be controlled in these countries by 2030 (ensuring early detection and prompt response to contain outbreaks). This review aimed to understand the epidemiology of cholera in Nigeria, Africa and the world at large, to access the level of spread, management and preventive measures so far implemented in the endemic regions.

scholarly journals Modelling the drivers of the spread of Plasmodium falciparum hrp2 gene deletions in sub-Saharan Africa

eLife ◽  
2017 ◽  
Vol 6 ◽  
Author(s):  
Oliver J Watson ◽  
Hannah C Slater ◽  
Robert Verity ◽  
Jonathan B Parr ◽  
Melchior K Mwandagalirwa ◽  
...  
Keyword(s):  
Democratic Republic Of Congo ◽  
False Negative ◽  
Malaria Diagnosis ◽  
Parasite Prevalence ◽  
Malaria Prevalence ◽  
Sub Saharan Africa ◽  
Gene Deletions ◽  
High Frequencies ◽  
Sub Saharan ◽  
Selection Of

Rapid diagnostic tests (RDTs) have transformed malaria diagnosis. The most prevalent P. falciparum RDTs detect histidine-rich protein 2 (PfHRP2). However, pfhrp2 gene deletions yielding false-negative RDTs, first reported in South America in 2010, have been confirmed in Africa and Asia. We developed a mathematical model to explore the potential for RDT-led diagnosis to drive selection of pfhrp2-deleted parasites. Low malaria prevalence and high frequencies of people seeking treatment resulted in the greatest selection pressure. Calibrating our model against confirmed pfhrp2-deletions in the Democratic Republic of Congo, we estimate a starting frequency of 6% pfhrp2-deletion prior to RDT introduction. Furthermore, the patterns observed necessitate a degree of selection driven by the introduction of PfHRP2-based RDT-guided treatment. Combining this with parasite prevalence and treatment coverage estimates, we map the model-predicted spread of pfhrp2-deletion, and identify the geographic regions in which surveillance for pfhrp2-deletion should be prioritised.

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