scholarly journals OC 8494 DRIVING REDUCED AIDS-ASSOCIATED MENINGO-ENCEPHALITIS MORTALITY

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A10.2-A10
Author(s):  
Angela Loyse ◽  
Godfrey S Mfinanga ◽  
Cecilia Kanyama ◽  
Charles Kounfack ◽  
Sokoine Lesikari ◽  
...  
Keyword(s):  
High Mortality ◽  
Routine Care ◽  
Sub Saharan Africa ◽  
Contributing Factors ◽  
Train The Trainer ◽  
Csf Analysis ◽  
Laboratory Capacity ◽  
Poor Access ◽  
Microbiological Techniques ◽  
Sub Saharan

BackgroundDREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.MethodsA before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.ResultsThe observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.

Delivering water services during protracted armed conflicts: How development agencies can overcome barriers to collaboration with humanitarian actors

2019 ◽  
Vol 101 (912) ◽  
pp. 1067-1089
Author(s):  
Edoardo Borgomeo
Keyword(s):  
Service Delivery ◽  
Armed Conflict ◽  
Armed Conflicts ◽  
Sub Saharan Africa ◽  
Contributing Factors ◽  
Emergency Relief ◽  
Organizational Goals ◽  
Post Conflict ◽  
Development Agencies ◽  
Sub Saharan

AbstractThis note discusses the challenges of water service delivery before, during and after protracted armed conflict, focusing on barriers that may impede successful transition from emergency to development interventions. The barriers are grouped according to three major contributing factors (three “C”s): culture (organizational goals and procedures), cash (financing practices) and capacity (know-how). By way of examples, the note explores ways in which development agencies can overcome these barriers during the three phases of a protracted armed conflict, using examples of World Bank projects and experiences in the Middle East and Sub-Saharan Africa. Before the crisis, development agencies need to work to prevent armed conflict. In a situation of active armed conflict or when conflict escalates, development agencies need to remain engaged as much as possible, as this will speed up post-conflict recovery. When conflict subsides, development agencies need to balance the relative effort placed on providing urgently needed emergency relief and water supply and sanitation services with the effort placed on re-establishing sector oversight roles and capacity of local institutions to oversee and manage service delivery in the long term.

scholarly journals “They Do Not Care about Us Anymore”: Understanding the Situation of Older People in Ghana

2021 ◽  
Vol 18 (5) ◽  
pp. 2337
Author(s):  
Joseph Asumah Braimah ◽  
Mark W. Rosenberg
Keyword(s):  
Older People ◽  
Lived Experiences ◽  
Climatic Factors ◽  
Sub Saharan Africa ◽  
Structural Factors ◽  
Sanitation Services ◽  
Poor Access ◽  
Access To Water ◽  
Sub Saharan ◽  
Sharing Circles

While existing research acknowledges copious challenges faced by older adults (people aged 60 and over) in Ghana and most countries in sub-Saharan Africa, they fail to situate the lived experiences of this vulnerable group within the broader context of health geography and public health. This paper draws insights from ecological systems theory and the “geographies of older people” literature to examine the lived experiences of older people in Ghana. Data for the study were gathered using interviews (42) and sharing circles (10). Our findings reveal a complex mix of experiences consistent with the different levels of the environment. Dominant themes include access to social support, functional impairment and poor health status, social status, poor access to water and sanitation services, food insecurity, economic insecurity, and caregiving burden. These findings support the wide-held notion that the experiences of older people are complex and produced by the interplay of both individual and structural factors. Our findings demonstrate that sociocultural, economic, political, and climatic factors are important consideration in promoting elderly wellbeing and quality of life in Ghana.

Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective Cohort Study

2021 ◽  
Author(s):  
Matthew J. Cummings ◽  
Barnabas Bakamutumaho ◽  
Nicholas Owor ◽  
John Kayiwa ◽  
Joyce Namulondo ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Sub Saharan Africa ◽  
Rapid Diagnostics ◽  
Suspected Sepsis ◽  
Laboratory Capacity ◽  
Antimicrobial Management ◽  
Sub Saharan ◽  
Tb 32

The global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age ≥18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26–42 years]; female, n = 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.

scholarly journals High mortality in subjects with both diabetes and HIV in sub-Saharan Africa

AIDS ◽  
2018 ◽  
Vol 32 (14) ◽  
pp. 2083-2084
Author(s):  
Philip I. Burgess ◽  
Simon P. Harding ◽  
Petros C. Kayange ◽  
Joep van Oosterhout ◽  
Marta García-Fiñana ◽  
...  
Keyword(s):  
High Mortality ◽  
Sub Saharan Africa ◽  
Sub Saharan

Community Education in New HIV Prevention Technologies Research

2009 ◽  
pp. 328-338
Author(s):  
Busi Nkala
Keyword(s):  
Hiv Infection ◽  
Community Involvement ◽  
New Technologies ◽  
Community Education ◽  
Sub Saharan Africa ◽  
Contributing Factors ◽  
Survival Sex ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Health Programmes

An estimated 39.5 million people are living with HIV worldwide. There were 4.3 million new infections in 2006 with 2.8 million (65%) of these occurring in sub-Saharan Africa with important increases in Eastern Europe and Central Asia, where there are some indications that infection rates have risen by more than 50% since 2004. In 2006, 2.9 million people died of AIDS-related illnesses (UNAIDS, 2006). The continued increase in new HIV infection is a call for concern. It is imperative that more innovative ways of combating the infections are found sooner. There is an enormous body of evidence that HIV infection is caused mainly by sexual contact. There is also undisputed evidence that there are other contributing factors such as extreme poverty, survival sex, gender inequality, lack of education, fatalism, religious barriers and others. This chapter seeks to support the need to do more research in finding new technologies and innovative ways of dealing with the spread of HIV. The chapter suggests that the involvement of researched communities be effectively involved. Involving communities in finding solutions will help, in that research protocols and health programmes will take into account the cultural acceptability of the new technologies and systems and ensure that recipients of health services become effective organs of change. The chapter seeks to highlight the fact that, if the recipients are involved in all stages of development of health programmes, including technologies, we may begin to see changes in how new technologies are taken up or may shift toward getting technologies that are acceptable. There are various suggested and implemented ways which aid in achieving the protection for individuals and communities; such as community involvement, community participation and community education (Collins, 2002; Gupta 2002), this chapter will focus on community education and a proposal for a community principle.

Risk Factors and Predictability of Famine in Ethiopia

1991 ◽  
Vol 9 (2) ◽  
pp. 187-203 ◽  
Author(s):  
Theodore M. Vestal
Keyword(s):  
Social Sciences ◽  
Risk Factors ◽  
Sub Saharan Africa ◽  
Complex Phenomenon ◽  
Medical Sciences ◽  
Contributing Factors ◽  
Limited Success ◽  
The Social ◽  
Sub Saharan ◽  
Analytical Tools

Famine, a complex phenomenon with multifactorial causes, produces starvation and associated diseases resulting in unusually high mortality from a lack of food. Devastating famines in sub-Saharan Africa in the 1980s may have provided an impetus for scholars to find additional analytical tools for predicting famines. Two predominant theories of famines causality are (1) food availability decline (FAD), a supply failure; and (2) the entitlement approach based on a demand failure. Findings from both theories are applied to specific examples from Ethiopian famines to analyze the composition and effects of famine. The limited success of contemporary famines studies in anticipating famine suggests the need for improved analytical tools. Risk factor analysis, used successfully in the social sciences and the medical sciences to predict the occurrence of complicated phenomena, is developed to identify controllable, uncontrollable, and contributing factors to famine. Based on the experience of Ethiopia in 1983-86, categorical cutoff values for identifying a high risk of developing famine are formulated.

scholarly journals Men from Sub-Saharan Africa Living in Worker Hostels in France: A Hidden Population with Poor Access to HIV Testing

2016 ◽  
Vol 19 (4) ◽  
pp. 991-994 ◽  
Author(s):  
M. Guiguet ◽  
S. Dionou ◽  
J. Volant ◽  
M. C. Samba ◽  
N. Benammar ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sub Saharan Africa ◽  
Hidden Population ◽  
Poor Access ◽  
Sub Saharan

Brain drain in sub-Saharan Africa: contributing factors, potential remedies and the role of academic medical centres

2012 ◽  
Vol 97 (11) ◽  
pp. 973-979 ◽  
Author(s):  
Jennifer Kasper ◽  
Francis Bajunirwe
Keyword(s):  
Clinical Skills ◽  
Codes Of Conduct ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Contributing Factors ◽  
Optimal Care ◽  
Poor Countries ◽  
Resource Limited ◽  
Sub Saharan ◽  
And Migration

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.

scholarly journals Gambian poultry isolates from hyperendemic group of AMR Escherichia coli strains in sub-Saharan Africa

2020 ◽  
Vol 2 (7A) ◽  
Author(s):  
Ebenezer Foster-Nyarko ◽  
Nabil-Fareed Alikhan ◽  
Anuradha Ravi ◽  
Nicholas Thomson ◽  
Sheikh Jarju ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Guinea Fowl ◽  
Sub Saharan Africa ◽  
Pathogenic Potential ◽  
E Coli ◽  
Antimicrobial Resistance Gene ◽  
Microbiological Techniques ◽  
Sub Saharan ◽  
Genomic Cluster ◽  
Sequence Types

Chickens and guinea fowl are commonly reared in Gambian homes as affordable sources of protein. Using standard microbiological techniques, we obtained 68 caecal isolates of Escherichia coli from ten chickens and nine guinea fowl in rural Gambia. After Illumina whole-genome sequencing, 28 sequence types were detected in the isolates (four of them novel), of which ST155 was the most common (22/68, 32%). These strains span four of the eight main phylogroups of E. coli, with phylogroups B1 and A being most prevalent. Nearly a third of the isolates harboured at least one antimicrobial resistance gene, while most of the ST155 isolates (14/22, 64%) encoded resistance to ≥3 classes of clinically relevant antibiotics, as well as putative virulence factors, suggesting pathogenic potential in humans. Furthermore, hierarchical clustering revealed that several Gambian poultry strains were closely related to isolates from humans. Although the ST155 lineage is common in poultry from Africa and South America, the Gambian ST155 isolates sit within a tight genomic cluster (100 alleles difference) of strains from poultry and livestock in sub-Saharan Africa (the Gambia, Uganda and Kenya). Continued surveillance of E. coli and other potential pathogens in rural backyard poultry from sub-Saharan Africa is warranted.

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