scholarly journals Caffeine for the care of preterm infants in sub-Saharan Africa: a missed opportunity?

2021 ◽  
Vol 6 (12) ◽  
pp. e007682
Author(s):  
Helen M Nabwera ◽  
Osayame A Ekhaguere ◽  
Haresh Kirpalani ◽  
Kathy Burgoine ◽  
Chinyere V Ezeaka ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Missed Opportunity

scholarly journals ‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216123
Author(s):  
Brenda Nyambura Mungai ◽  
Elizabeth Joekes ◽  
Enos Masini ◽  
Angela Obasi ◽  
Veronica Manduku ◽  
...  
Keyword(s):  
Population Based ◽  
Sub Saharan Africa ◽  
Radiological Findings ◽  
Prevalence Survey ◽  
X Ray ◽  
Chest X Ray ◽  
Sub Saharan ◽  
Significant Disease ◽  
Tuberculosis Prevalence ◽  
Missed Opportunity

BackgroundThe prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.MethodsWe reviewed a random sample of 1140 adult (≥15 years) CXRs classified as ‘abnormal, suggestive of TB’ or ‘abnormal other’ during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).

scholarly journals Evidence that informs feeding practices in very low birthweight and very preterm infants in sub-Saharan Africa: an overview of systematic reviews

2020 ◽  
Vol 4 (1) ◽  
pp. e000724
Author(s):  
Abimbola Akindolire ◽  
Alison Talbert ◽  
Ian Sinha ◽  
Nicholas Embleton ◽  
Stephen Allen
Keyword(s):  
Preterm Infants ◽  
Systematic Reviews ◽  
Low Birthweight ◽  
Sub Saharan Africa ◽  
Very Low Birthweight ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Resource Limited ◽  
Sub Saharan ◽  
Feed Volume

BackgroundOptimal feeding of very low birthweight (VLBW <1500 g)/very preterm (gestation <32 weeks) infants in resource-limited settings in sub-Saharan Africa (sSA) is critical to reducing high mortality and poor outcomes.ObjectiveTo review evidence on feeding of VLBW/very preterm infants relevant to sSA.MethodsWe searched the Cochrane Database of Systematic Reviews, Embase, PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to July 2019 to identify reviews of randomised and quasi-randomised controlled trials of feeding VLBW/very preterm infants. We focused on interventions that are readily available in sSA. Primary outcomes were weight gain during hospital stay and time to achieve full enteral feeds (120 mL/kg/day). Secondary outcomes were growth, common morbidities, mortality, duration of hospital stay and cognitive development. Quality of evidence (QOE) was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR2).ResultsEight systematic reviews were included. Higher feed volume of day 1 (80 mL/kg) reduced late-onset sepsis and time to full enteral feeds, and higher feed volume (up to 300 mL/kg/day) improved weight gain without adverse events (QOE: low–moderate). Rapid advancement of feeds (30–40 mL/kg/day) was not associated with harm. Breast milk fortification with energy and protein increased growth and with prebiotics increased growth and reduced duration of admission (QOE: low–very low) and did not result in harm. Evidence regarding feeding tube placement and continuous versus bolus feeds was insufficient to draw conclusions. We found no reviews meeting our selection criteria regarding when to start feeds, use of preterm formula, cup-and-spoon feeding or gravity versus push feeds and none of the reviews included trials from low-income countries of sSA.ConclusionsThe evidence base informing feeding of VLBW/very preterm babies in resource-limited settings in sSA is extremely limited. Pragmatic studies are needed to generate evidence to guide management and improve outcomes for these highly vulnerable infants.PROSPERO registration numberCRD42019140204.

RTS,S/AS01, a vaccine targeting pre-erythrocytic stages of Plasmodium falciparum

2017 ◽  
Vol 1 (6) ◽  
pp. 533-537
Author(s):  
Lorenz von Seidlein ◽  
Borimas Hanboonkunupakarn ◽  
Podjanee Jittmala ◽  
Sasithon Pukrittayakamee
Keyword(s):  
Protective Efficacy ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
Phase Iii ◽  
European Medicines Agency ◽  
Older Children ◽  
Pivotal Phase ◽  
Malaria Epidemiology ◽  
Maximum Benefit ◽  
Sub Saharan

RTS,S/AS01 is the most advanced vaccine to prevent malaria. It is safe and moderately effective. A large pivotal phase III trial in over 15 000 young children in sub-Saharan Africa completed in 2014 showed that the vaccine could protect around one-third of children (aged 5–17 months) and one-fourth of infants (aged 6–12 weeks) from uncomplicated falciparum malaria. The European Medicines Agency approved licensing and programmatic roll-out of the RTSS vaccine in malaria endemic countries in sub-Saharan Africa. WHO is planning further studies in a large Malaria Vaccine Implementation Programme, in more than 400 000 young African children. With the changing malaria epidemiology in Africa resulting in older children at risk, alternative modes of employment are under evaluation, for example the use of RTS,S/AS01 in older children as part of seasonal malaria prophylaxis. Another strategy is combining mass drug administrations with mass vaccine campaigns for all age groups in regional malaria elimination campaigns. A phase II trial is ongoing to evaluate the safety and immunogenicity of the RTSS in combination with antimalarial drugs in Thailand. Such novel approaches aim to extract the maximum benefit from the well-documented, short-lasting protective efficacy of RTS,S/AS01.

Mortality and Society in Sub-Saharan Africa

1993 ◽  
Vol 47 (3) ◽  
pp. 555-556
Author(s):  
Lado Ruzicka
Keyword(s):  
Sub Saharan Africa ◽  
Sub Saharan

Adolescent Suicidality as Seen in Rural Northeastern Uganda

Crisis ◽  
2011 ◽  
Vol 32 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Eugene Kinyanda ◽  
Ruth Kizza ◽  
Jonathan Levin ◽  
Sheila Ndyanabangi ◽  
Catherine Abbo
Keyword(s):  
Low Socioeconomic Status ◽  
Sub Saharan Africa ◽  
Psychosocial Risk ◽  
Psychiatric Nurses ◽  
Health Concern ◽  
Cross Sectional ◽  
Childhood Experiences ◽  
Low Socioeconomic ◽  
Dsm Iv ◽  
Sub Saharan

Background: Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. Aims: A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. Methods: A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3–19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10–19 years; n = 897) was undertaken. Results: Lifetime suicidality in this study was 6.1% (95% CI, 4.6%–7.9%). Conclusions: Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.

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