scholarly journals Hypofractionation and prostate cancer: A good option for Africa?

2017 ◽  
Vol 1 ◽  
pp. 3
Author(s):  
Luca Incrocci ◽  
Ben Heijmen ◽  
Patrick Kupelian ◽  
Hannah M. Simonds
Keyword(s):  
Prostate Cancer ◽  
Low Income ◽  
External Beam Radiotherapy ◽  
Public Health Problem ◽  
World Health ◽  
Low Income Countries ◽  
Therapeutic Window ◽  
African Countries ◽  
Image Guided Radiotherapy ◽  
Volume Delineation

Cancer is an emerging public health problem in Africa. According to the World Health Organization, the numbers will be doubled by 2030 because of the ageing and the growth of the population. Prostate cancer is the most common cancer among men in most African countries. Radiotherapy machines are extremely limited in Africa and therefore prostate cancer in Africa is mostly managed by urologists. However, for a large proportion of prostate cancer patients, external-beam radiotherapy (EBRT) will be the treatment of choice in Africa because of limitations of surgical expertise in many countries. The disparity between the <em>α/β</em> ratio for late complications and the low <em>α/β</em> ratio for prostate cancer widens the therapeutic window when treating prostate cancer with hypofractionation. Because of the reduced number of treatment days, hypofractionation offers economic and logistic advantages, reducing the burden of the very limited radiotherapy resources in most African countries. It also increases patient convenience. A misleading assumption is that high-level radiotherapy is not feasible in low-income countries. The gold standard option for hypofractionation includes daily image-guided radiotherapy with 3–4 implanted gold fiducials. Acceptable methods for image guidance include ultrasound and cone-beam computed tomography (CT). CT-based treatment planning with magnetic resonance imaging fusion allows for accurate volume delineation. Volumetric modulated arc therapy or inversely planned intensity modulated radiotherapy is the ideal for treatment delivery. The most vital component is safe delivery, which necessitates accurate quality assurance measures and on-board imaging. We will review the evidence and potential utilisation of hypofractionated EBRT in Africa.

Africa's cancer burden to rise without funding shift

2015 ◽  
Keyword(s):  
Low Income ◽  
Urban Areas ◽  
Economic Benefits ◽  
World Health ◽  
Low Income Countries ◽  
Health Priorities ◽  
African Countries ◽  
Content Type ◽  
Cancer Burden ◽  
Market Expansion

Subject Cancer burden in Africa. Significance Cancer is a growing public health threat in low-income countries, including African states. With the increase in urbanisation, population growth and improving mortality rates, the World Health Organisation (WHO) estimates that by 2020, 16 million new cases of cancer will be diagnosed each year, with 70% of those in low-income countries. However, the rise in cancer rates has not been met with changes to aid funding. Global health priorities continue to emphasise infectious diseases, and African countries remain ill-equipped to prevent, diagnose or treat cancer. Impacts Rising consumption of processed foods in urban areas will contribute to an overall rise in non-communicable diseases. African countries are some of the fastest growing markets for tobacco companies as health awareness rises in traditional markets. Global brewers will enjoy significant market expansion in Africa, contributing to increased alcohol consumption. Despite the economic benefits, delayed childbearing and lower fertility in women is set to increase the incidence of breast cancer.

scholarly journals Perceived Stigma Towards Mental Illness and Its Associated Factors among Community People of Pokhara Metropolitan, Kaski, Nepal

2020 ◽  
Vol 10 (2) ◽  
pp. 28-35
Author(s):  
Biddhya Bhattarai ◽  
Jenny Ojha
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Low Income ◽  
Associated Factors ◽  
Mental Health Problems ◽  
Public Health Problem ◽  
World Health ◽  
Low Income Countries ◽  
Perceived Stigma ◽  
Community People

Introduction: Mental illness is a major and neglected public health problem. People suffering from mental health problems are among the foremost stigmatized, discriminated, marginalized, disadvantaged and vulnerable members of our society. According to the World Health Organization, 450 million people are suffering from mental illness worldwide and around 80% of them live in middle and low-income countries. In spite of the high burden of mental disorders, globally, around 70% of people with mental illness do not receive any treatment, and evidence suggests that stigma plays a major role in treatment avoidance. The objective of this study is to assess the level of perceived stigma towards mental illness and its associated factors among community people of Pokhara Metropolitan. Methods: A community based descriptive cross-sectional study was conducted among the people of Pokhara Metropolitan. Systematic random sampling was employed for the selection of 292 participants. Face to face interview was conducted for the data collection using Community Attitude Towards Mental Illness (CAMI) scale. Chi square test was used to find the association between variables and stigma towards mental illness on different subscales of CAMI scale. Results: The overall prevalence of stigma towards mental illness was 72.9%. The prevalence of stigma was high under all the four domains of CAMI scale. Age, education, occupation and income were significantly associated with stigma score in all domains. Marital status had significant association to authoritarian as well as social restrictiveness domains score. However, sex and family history of mental illness was associated with Benevolence and community mental health ideology score respectively. Conclusion: The findings of the study depicted that stigma towards mental illness is high among the community people in all four subscales of CAMI scale. The study has revealed the stigma towards mental illness is  influenced by the various socio-demographic and socioeconomic factors. This study suggested that there is strong need to eliminate the stigma associated with mental illness to improve the mental health status of the region.

Monetary Policy in Sub-Saharan Africa

2018 ◽  
Keyword(s):  
Monetary Policy ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
African Countries ◽  
Policy Regimes ◽  
Export Prices ◽  
Policy Work ◽  
Sub Saharan ◽  
Policy Guidance

Having broadly stabilized inflation over the past two decades, many policymakers in sub-Saharan Africa are now asking more of their monetary policy frameworks. They are looking to avoid policy misalignments and respond appropriately to both domestic and external shocks, including swings in fiscal policy and spikes in food and export prices. In many cases they are finding current regimes—often characterized as ‘money targeting’—lacking, with opaque and sometimes inconsistent objectives, inadequate transmission of policy to the economy, and difficulties in responding to supply shocks. At the same time, little existing research on monetary policy is targeted to low-income countries. What do we know about the empirics of monetary transmission in low-income countries? (How) Does monetary policy work in countries characterized by a huge share of food in consumption, underdeveloped financial markets, and opaque policy regimes? (How) Can we use methods largely derived in advanced countries to answer these questions? And (how) can we use the results to guide policymakers? This book draws on years of research and practice at the IMF and in central banks from the region to shed empirical and theoretical light on these questions and to provide practical tools and policy guidance. A key feature of the book is the application of dynamic general equilibrium models, suitably adapted to reflect key features of low-income countries, for the analysis of monetary policy in sub-Saharan African countries.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

Infrastructure deficit and opportunities in Africa

2017 ◽  
Author(s):  
Albert Mafusire ◽  
Zuzana Brixiova ◽  
John Anyanwu ◽  
Qingwei Meng
Keyword(s):  
Private Sector ◽  
Low Income ◽  
Private Investment ◽  
Low Income Countries ◽  
Infrastructure Development ◽  
African Countries ◽  
Policy Makers ◽  
Private Sector Investment ◽  
Investment Opportunities ◽  
Financing Infrastructure

Private sector investment opportunities in Africa’s infrastructure are huge. Regulatory reforms across African countries are identified as critical to the realization of the expected investment flows in the infrastructure sector. However, planners and policy makers need to note that there are infrastructure deficiencies in all subsectors with low income countries (LICs) in Africa facing the greatest challenge. Inefficiencies in implementing infrastructure projects account for USD 17 billion annually and improving the capacity of African countries will help minimize these costs. In this regard, the donor community must play a greater role in African LICs while innovative financing mechanisms must be the focus in the relatively richer countries of the continent. Traditional sources of financing infrastructure development remain important but private investment is critical in closing the current gaps. Countries need to devise mechanisms to exploit opportunities and avoid pitfalls in investing in infrastructure.

scholarly journals Pooled Sputum for Xpert MTB/RIF Testing: A Cost Effectiveness Diagnostic Tool in Mwanza, Tanzania

2021 ◽  
Author(s):  
Shimba Henerico ◽  
Richard V. Makapa ◽  
Bernard C. Okamo ◽  
Benson R. Kidenya ◽  
Geoffrey Japhet ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Public Health Problem ◽  
Positive Sample ◽  
Low Income Countries ◽  
Global Public Health ◽  
Testing Strategy ◽  
Pooled Testing ◽  
The Individual ◽  
Pooled Samples

Abstract Background: Tuberculosis (TB) is a global public health problem, with the highest burden occurring in low-income countries, wherein the use of more sensitive diagnostics, such as Xpert MTB/RIF (GeneXpert), is still limited by costs. Testing of pooled samples from various individuals has been thought and thus investigated as a cost saving strategy to diagnose some diseases including TB. Then in cases where a pool is positive, retesting of the individual samples in that pool is done to identify the positive sample. We assessed the utility of a pooled testing strategy to optimize the affordability of GeneXpert for the diagnosis of TB Mwanza Tanzania. Methods: Remainder of samples from presumptive TB patients submitted for routine TB diagnosis were used for pooled samples (5 per pool) testing. The agreement of the results between individual sample testing against pooled samples testing and cost-effectiveness were assessed.Results: A total of 250 individual routinely submitted samples for TB diagnosis were tested using the established protocols. The median age of study participants was 35 [IQR 27 – 40] years and 143 (57.2%) were males. Of the 250 samples, 28 (11.2%) were detected to have MTB whereas 222 (88.8%) samples, were negative. Of the 50 sputum pools made, MTB were detected in 17 (34.0%) pools. Following retesting of these 17 positive pools, all 28 (100%) individual MTB samples were detected with the overall agreement being 100% (With the sensitivity of 100% and specificity of 100%). The number of individual MTB positive ranged from 1 to 3 per pool. Using pooling of sputum samples, the technique saved 115 (46.0%) of the cartridges in running 250 samples. This is equivalent to saving US$ 1147.7. Conclusion: The pooled sputum testing strategy reduced cartridge costs by 46.0%. The use of the pooled testing strategy reduces costs and has the potential to increase the affordability of GeneXpert testing in countries with limited resources. Pooled sputum for Xpert MTB/RIF can be used as an affordable diagnostic and/or screening tool in resource limited settings, such as Tanzania.

scholarly journals Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya

2020 ◽  
Author(s):  
Faith A. Okalebo ◽  
Eric M. Guantai ◽  
Aggrey O. Nyabuti
Keyword(s):  
Drug Use ◽  
Low Income ◽  
Primary Healthcare ◽  
Essential Medicines ◽  
World Health ◽  
Low Income Countries ◽  
Rational Use ◽  
Health Organization ◽  
Consultation Time ◽  
Primary Healthcare Centers

ABSTRACTBackgroundIrrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study set out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/ International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology.MethodsTen PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three-hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use.ResultsThe average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6– 1.8), percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%) and percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available.ConclusionThe survey shows irrational drug use practices, particularly polypharmacy, non-generic prescribing, overuse of antibiotics, short consultation time and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

scholarly journals The acceptance of covid-19 vaccines in Sub-Saharan Africa: Evidence from 6 national phone surveys

2021 ◽  
Author(s):  
Shelton Kanyanda ◽  
Yannick Markhof ◽  
Philip Wollburg ◽  
Alberto Zezza
Keyword(s):  
Side Effects ◽  
Low Income ◽  
Urban Areas ◽  
Vaccine Coverage ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Vaccine Hesitancy ◽  
African Countries ◽  
Representative Sampling ◽  
Sub Saharan

Introduction Recent debates surrounding the lagging covid-19 vaccination campaigns in low-income countries center around vaccine supply and financing. Yet, relatively little is known about attitudes towards covid-19 vaccines in these countries and in Africa in particular. In this paper, we provide cross-country comparable estimates of the willingness to accept a covid-19 vaccine in six Sub-Saharan African countries. Methods We use data from six national high-frequency phone surveys from countries representing 38% of the Sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria, and Uganda). Samples are drawn from large, nationally representative sampling frames providing a rich set of demographic and socio-economic characteristics by which we disaggregate our analysis. Using a set of re-calibrated survey weights, our analysis adjusts for the selection biases common in remote surveys. Results Acceptance rates in the six Sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects emerge as the primary reservations toward a covid-19 vaccine across countries. Conclusions Our findings suggest that limited supply, not inadequate demand, likely presents the key bottleneck to reaching high covid-19 vaccine coverage in Sub-Saharan Africa. To turn intent into effective demand, targeted communication campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world's poorest regions.

INTERNATIONAL DEVELOPMENT ISSUES

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 395-395
Author(s):  
Keyword(s):  
International Development ◽  
Low Income ◽  
Development Aid ◽  
Military Expenditure ◽  
World Health ◽  
Low Income Countries ◽  
River Blindness ◽  
Eradication Programme ◽  
Set Up ◽  
Health Organization

The annual military bill is now approaching 450 billion US dollars, while official development aid accounts for less than 5 per cent of this figure. Four examples: 1. The military expenditure of only half a day would suffice to finance the whole malaria eradication programme of the World Health Organization, and less would be needed to conquer river-blindness, which is still the scourge of millions. 2. A modern tank costs about one million dollars; that amount could improve storage facilities for 100,000 tons of rice and thus save 4000 tons or more annually; one person can live on just over a pound of rice a day. The same sum of money could provide 1000 classrooms for 30,000 children. 3. For the price of one jet fighter (20 million dollars) one could set up about 40,000 village pharmacies. 4. One-half of one per cent of one year's world military expenditure would pay for all the farm equipment needed to increase food production and approach self-sufficiency in food-deficit low-income countries by 1990.

Managing and Motivating

2011 ◽  
pp. 79-95
Author(s):  
Eilish Mc Auliffe ◽  
Ogenna Manafa ◽  
Cameron Bowie ◽  
Lucy Makoae ◽  
Fresier Maseko ◽  
...  
Keyword(s):  
Human Resources ◽  
Low Income ◽  
Low Income Countries ◽  
Critical Element ◽  
African Countries ◽  
Bilateral Agreements ◽  
Working Environments ◽  
Sub Saharan ◽  
And Performance ◽  
Source Countries

It is now more than a decade since the acknowledgement of the health human resources crisis that exists in many low-income countries. During that decade much attention has focused on addressing the “pull” factors (e.g. developing voluntary international recruitment guidelines and bilateral agreements between recruiting and source countries) and on scaling up the supply of health professionals. Drawing on research conducted in two sub-Saharan African countries, we argue that a critical element in the human resources crisis is the poor working environments in these countries that not only continue to act as a strong “push” factor, but also impact on the motivation and performance of those who remain in their home countries. Unless attention is focused on improving work environments, the human resources crisis will continue in a vicious cycle leading to further decline in the health systems of low-income countries.

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