scholarly journals Feasibility Study of a Smartphone Application for Detecting Skin Cancers in People With Albinism

2020 ◽  
pp. 1370-1375
Author(s):  
Fidel Rubagumya ◽  
Sarah K. Nyagabona ◽  
Ahuka N. Longombe ◽  
Achille Manirakiza ◽  
John Ngowi ◽  
...  
Keyword(s):  
Skin Color ◽  
Care Delivery ◽  
Mobile Apps ◽  
Diagnostic Delay ◽  
Smartphone Application ◽  
Mobile App ◽  
Sub Saharan Africa ◽  
Histologic Diagnosis ◽  
Skin Cancers ◽  
Sub Saharan

PURPOSE Albinism affects some facets of the eye’s function and coloration, as well as hair and skin color. The prevalence of albinism is estimated to be one in 2,000-5,000 people in sub-Saharan Africa and one in 270 in Tanzania. People in Tanzania with albinism experience sociocultural and economic disparities. Because of stigma related to albinism, they present to hospitals with advanced disease, including skin cancers. Mobile health (mHealth) can help to bridge some of the gaps in detection and treatment of skin cancers affecting this population. METHODS We assessed the feasibility of using a mobile application (app) for detection of skin cancers among people with albinism. The study was approved by the Ocean Road Cancer Institute institutional review board. Data, including pictures of the lesions, were collected using a mobile smartphone and submitted to expert reviewers. Expert reviewers’ diagnosis options were benign, malignant, or unevaluable. RESULTS A total of 77 lesions from different body locations of 69 participants were captured by the NgoziYangu mobile app. Sixty-two lesions (81%) were considered malignant via the app and referred for biopsy and histologic diagnosis. Of those referred, 55 lesions (89%) were biopsied, and 47 lesions (85%) were confirmed as skin malignancies, whereas eight (15%) were benign. CONCLUSION With an increasing Internet coverage in Africa, there is potential for smartphone apps to improve health care delivery channels. It is important that mobile apps like NgoziYangu be explored to reduce diagnostic delay and improve the accuracy of detection of skin cancer, especially in stigmatized groups.

scholarly journals QOLP-03. NEURO-ONCOLOGY PALLIATIVE CARE SURVEY OF PHYSICIANS IN SUB-SAHARAN AFRICA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii175-ii175
Author(s):  
Ramya Tadipatri ◽  
Amir Azadi ◽  
Madison Cowdrey ◽  
Samuel Fongue ◽  
Paul Smith ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Cultural Beliefs ◽  
Oral Feeding ◽  
Statistical Testing ◽  
Sub Saharan Africa ◽  
Neurological Deficits ◽  
Survey Study ◽  
Prior Training ◽  
Sub Saharan

Abstract BACKGROUND Early access to palliative care is a critical component of treating patients with advanced cancer, particularly for glioblastoma patients who have low rates of survival despite optimal therapies. Additionally, there are unique considerations for primary brain tumor patients given the need for management of headaches, seizures, and focal neurological deficits. METHODS We conducted a survey of 109 physicians in Sub-Saharan Africa in order to determine level of understanding and skill in providing palliative care, types of palliative care therapies provided, role of cultural beliefs, availability of resources, and challenges faced. Demographic data including age, gender, and prior training was collected and analyzed using ANOVA statistical testing. RESULTS Among the participants, 48% felt comfortable in providing palliative care consultations, 62% have not had prior training, 52% believed that palliative care is only appropriate when there is irreversible deterioration, 62% expressed having access to palliative care, 49% do not have access to liquid opioid agents, 50% stated that cultural beliefs held by the patient or family prevented them from receiving, palliative care, and 23% stated that their own beliefs affected palliative care delivery. Older providers (age > 30) had a clearer understanding of palliative care (p = 0.004), were more comfortable providing consultation (p = 0.052), and were more likely to address mental health (p < 0.001). CONCLUSIONS Palliative care delivery to glioblastoma patients in Sub-Saharan Africa is often delayed until late in the disease course. Barriers to adequate palliative care treatment identified in this survey study include lack of training, limited access to liquid opioid agents, and cultural beliefs. Challenges most often identified by participants were pain management and end-of-life communication skills, but also included patient spirituality and psychological support, anxiety and depression, terminal dyspnea, ethics, and intravenous hydration and non-oral feeding.

scholarly journals Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

2017 ◽  
Vol 31 (1) ◽  
pp. 109-138 ◽  
Author(s):  
Mark J. Siedner
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

scholarly journals Scaling-up health insurance through community- based health insurance schemes in rural sub- Saharan African communities

2013 ◽  
Vol 3 (1) ◽  
pp. 14 ◽  
Author(s):  
Ufuoma John Ejughemre
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Rural Communities ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
Community Based ◽  
Seek Health Care ◽  
Community Based Health Insurance ◽  
The Poor ◽  
Sub Saharan

Context: The knotty and monumental problem of health inequality and the high burden of diseases in sub-Saharan Africa bothers on the poor state of health of many of its citizens particularly in rural communities. These issues are further exacerbated by the harrowing conditions of health care delivery and the poor financing of health services in many of these communities. Against these backdrops, health policy makers in the region are not just concerned with improving peoples’ health but with protecting them against the financial costs of illness. What is important is the need to support more robust strategies for healthcare financing in these communities in sub-Saharan Africa. Objective: This review assesses the evidence of the extent to which community-based health insurance (CBHI) is a more viable option for health care financing amongst other health insurance schemes in rural communities in sub-Saharan Africa. Patterns of health insurance in sub-Saharan Africa: Theoretically, the basis for health insurance is that it allows for risk pooling and therefore ensures that resources follow sick individuals to seek health care when needed. As it were, there are different models such as social, private and CBHI schemes which could come to bear in different settings in the region. However, not all insurance schemes will come to bear in rural settings in the region. Community based health insurance: CBHI is now recognized as a community-initiative that is community friendly and has a wide reach in the informal sector especially if well designed. Experience from Rwanda, parts of Nigeria and other settings in the region indicate high acceptability but the challenge is that these schemes are still very new in the region. Recommendations and conclusion: Governments and international development partners in the region should collect- ively develop CBHI as it will help in strengthening health systems and efforts geared towards achieving the millennium development goals. This is because it is inextricably linked to the health care needs of the poor. 

scholarly journals Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

2019 ◽  
Vol 16 (5) ◽  
pp. 728
Author(s):  
Saria Hassan ◽  
Alexis Cooke ◽  
Haneefa Saleem ◽  
Dorothy Mushi ◽  
Jessie Mbwambo ◽  
...  
Keyword(s):  
Care Delivery ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Initiation Rate ◽  
Hiv Services ◽  
Art Initiation ◽  
Care Integration ◽  
Therapy Strategy ◽  
Sub Saharan

There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.

scholarly journals Squamous Cell Carcinoma in African Children with Xeroderma Pigmentosum: Three Case Reports

2016 ◽  
Vol 8 (3) ◽  
pp. 311-318 ◽  
Author(s):  
Mamadou Kaloga ◽  
Pauline Dioussé ◽  
Boubacar Ahy Diatta ◽  
Mariama Bammo ◽  
Sarah Kourouma ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Xeroderma Pigmentosum ◽  
Case Reports ◽  
Sub Saharan Africa ◽  
Skin Cancers ◽  
Black Skin ◽  
The Mean ◽  
Sub Saharan

Introduction: Xeroderma pigmentosum is a rare autosomal recessive genetic disease. This disease predisposes patients to early-onset skin cancers, particularly squamous cell carcinoma. Here, we report 3 pediatric cases, including 2 deaths. Observation: The subjects included 2 boys and 1 girl with skin type VI. All subjects were from consanguineous marriages, and the average age was 7.6 years. The patients all had ulcerative budding tumor lesions in the cephalic region, and the mean disease duration was 18 months. In all 3 cases, the diagnosis of xeroderma pigmentosum was made before the poikilodermal appearance of sun-exposed areas and photophobia. Neurological-type mental retardation was noted in 1 case. Histology confirmed squamous cell carcinoma in all 3 cases. The evolutions were marked by the death of 2 children (cases 1 and 3). In one case, the outcome was favorable following cancer excision and subsequent chemotherapy with adjuvant radiotherapy. Conclusion: Squamous cell carcinoma is a serious complication related to xeroderma pigmentosum in Sub-Saharan Africa. Prevention is based on the early diagnosis of xeroderma pigmentosum, black skin photoprotection, screening and early treatment of lesions, and genetic counseling.

Ghanaian Immigrants’ Experiences With and Perceptions of U.S. Police

2016 ◽  
Vol 41 (4) ◽  
pp. 469-487 ◽  
Author(s):  
Daniel K. Pryce
Keyword(s):  
United States ◽  
Focus Groups ◽  
Skin Color ◽  
The United States ◽  
Policy Implications ◽  
Sub Saharan Africa ◽  
Immigrant Community ◽  
Human Interactions ◽  
Ghanaian Immigrants ◽  
Sub Saharan

Focus groups help researchers obtain rich, experiential data in order to increase our sociological and psychological understanding of human interactions. In this study, I used qualitative data obtained from two focus groups, comprising 13 participants from the Ghanaian community, to understand Ghanaian immigrants’ personal experiences with and perceptions of the police in the United States. The rise in immigration from sub-Saharan Africa means that these immigrants’ views of and experiences with the police will become increasingly important to successful policing in local communities across the United States. The results of this study point to the need for U.S. police to employ procedural justice and distributive justice in their dealings with Ghanaian immigrants. These immigrants also believe that both their skin color and foreign accent pose a disadvantage when dealing with police. By addressing these concerns, the U.S. police would gain the trust and cooperation of the Ghanaian immigrant community. The policy implications of the findings are discussed.

scholarly journals HEALTH EDUCATION AND COMMUNITY MOBILIZATION IN NIGERIA - ISSUES AND PROSPECTS

2020 ◽  
Author(s):  
Ekpomebe Elozino ◽  
Leonard E. Ananomo ◽  
Andrew Abanum Onome Vivian
Keyword(s):  
Health Care ◽  
Health Education ◽  
Health Care Delivery ◽  
Care Delivery ◽  
National Development ◽  
International Health ◽  
Community Mobilization ◽  
Sub Saharan Africa ◽  
International Health Organizations ◽  
Sub Saharan

The significance of health to national development and poverty eradication over the centuries, in that improving health status and increasing life expectancy adds to long term economic growth. This article examined the condition of health education and community mobilization in Nigeria's health care delivery. Health literacy is imperative to power and sustains government efforts in fostering health for all. Many developing countries, particularly those in Sub-Saharan Africa, in the 1970s witnessed remarkable and improper inequalities in the provision and delivery of health services. This contributed to and explained the exploration of diverse approaches to enhance health care delivery by international health organizations.

scholarly journals DO OLDER ADULTS WITH HIV HAVE A SOCIAL NETWORK DEFICIT? EVIDENCE FROM AGINCOURT, SOUTH AFRICA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S176-S176
Author(s):  
Markus H Schafer ◽  
Laura Upenieks ◽  
Julia DeMaria
Keyword(s):  
South Africa ◽  
Older Adults ◽  
Social Networks ◽  
Care Delivery ◽  
Well Being ◽  
Sub Saharan Africa ◽  
Hiv Status ◽  
Form And Function ◽  
Egocentric Network ◽  
Sub Saharan

Abstract HIV/AIDS has had a substantial social and economic impact on Sub-Saharan Africa, and research is only beginning to examine the prevalence and consequences of HIV infection among older adults in this region. Though informal social networks provide crucial resources for older people managing health problems, little is known about how the form and function of such networks differs by HIV status. Drawing from theories of health stigma and network mobilization, we use egocentric network data from HAALSI, the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (N=5,059). HAALSI is a community-based study centered in Agincourt, South Africa, and focuses on adults ≥40 years of age. Approximately 12% of this sample is HIV positive. Results of multivariable logistic and Poisson regression reveal three main findings. First, relative to those without HIV, infected older adults have larger personal networks—including more kin and more non-kin network members. Second, HIV status has no discernible impact on whether people receive regular emotional support from those in their networks. Third, older adults who have disclosed their HIV status have a relatively high proportion of kin members in the close networks relative to those not infected with HIV and to those with HIV who have not disclosed their disease. Our findings point to the need for further research on the implications of social networks for outcomes such as well-being and health care delivery among older AIDS patients in the Global South.

scholarly journals Neuromeningeal cryptococcosis in sub-Saharan Africa: Killer disease with sparse data

2015 ◽  
Vol 6 (02) ◽  
pp. 221-224 ◽  
Author(s):  
Komi Assogba ◽  
Mofou Belo ◽  
Majeste Ihou Wateba ◽  
Dieu Donné Gnonlonfoun ◽  
Paul M. Ossou-Inguiet ◽  
...  
Keyword(s):  
Diagnostic Delay ◽  
Clinical Signs ◽  
Latex Agglutination ◽  
Sub Saharan Africa ◽  
Impaired Consciousness ◽  
India Ink ◽  
International Data ◽  
The Mean ◽  
Sub Saharan ◽  
Heavy Mortality

ABSTRACT Introduction: The extent of neuromeningeal cryptococcosis (NMC) has increased since the advent of HIV/AIDS. It has non-specific clinical signs but marked by high mortality. Objective: To analyze the characteristics of the NMC in sub-Saharan Africa. Materials and Methods: We have conducted a literature reviewed on the NMC in sub-Saharan Africa from the publications available on the basis of national and international data with keywords such as “Cryptococcus, Epidemiology, Symptoms, Outcomes and Mortality” and their equivalent in French in July 2011. All publications from 1990 to 2010 with 202 references were analyzed. The following results are the means of different studied variables. Results: We selected in final 43 publications dealing with the NMC which 24 involved 17 countries in Africa. The average age was 36 years old. The average prevalence was 3.41% and the average incidence was 10.48% (range 6.90% to 12%). The most common signs were fever (75%), headaches (62.50%) and impaired consciousness. Meningeal signs were present in 49% of cases. The mean CD4 count was 44.8cells/mm3. The India ink and latex agglutination tests were the most sensitive. The average time before the consultation and the hospital stay was almost identical to 27.71 days. The average death rate was 45.90%. Fluconazole has been the most commonly used molecule. Conclusion: The epidemiological indicators of NMC varied more depending on the region of sub-Saharan Africa. Early and effective taking care of patients to reduce diagnostic delay and heavy mortality remains the challenges.

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