Case Report: Severe Dental Abscess Complications in Rural Sierra Leone

Prevalence data on severe dental infections is scarce, particularly for low-income countries. Patients with dental abscess complications who presented from September 2020 until December 2020 in two hospitals in Tonkolili District, Sierra Leone, were included into this case series. We report on a total of 20 patients, median age 28 years, with severe complications of dental abscesses, with a mortality rate of 45%. This case series illustrates the severity of the dire consequences of the absence of access to basic dental and oral healthcare.

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No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03747-2 ◽

2021 ◽

Author(s):

F. Wichlas ◽

V. Hofmann ◽

M. Moursy ◽

G. Strada ◽

C. Deininger

Keyword(s):

Surgical Treatment ◽

Soft Tissue ◽

Sierra Leone ◽

Low Income ◽

Soft Tissue Defect ◽

Low Income Countries ◽

Pelvic Surgery ◽

Closed Fractures ◽

Trauma Triage ◽

Tissue Defects

Abstract Introduction In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. Material and methods We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015–08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. Results We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. Conclusion One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.

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The Rotavirus Vaccine Landscape, an Update

Pathogens ◽

10.3390/pathogens10050520 ◽

2021 ◽

Vol 10 (5) ◽

pp. 520

Author(s):

Roberto Cárcamo-Calvo ◽

Carlos Muñoz ◽

Javier Buesa ◽

Jesús Rodríguez-Díaz ◽

Roberto Gozalbo-Rovira

Keyword(s):

Developing Countries ◽

Mortality Rate ◽

Low Income ◽

State Of The Art ◽

The State ◽

Cold Chain ◽

Low Income Countries ◽

Rotavirus Vaccine ◽

Oral Vaccines

Rotavirus is the leading cause of severe acute childhood gastroenteritis, responsible for more than 128,500 deaths per year, mainly in low-income countries. Although the mortality rate has dropped significantly since the introduction of the first vaccines around 2006, an estimated 83,158 deaths are still preventable. The two main vaccines currently deployed, Rotarix and RotaTeq, both live oral vaccines, have been shown to be less effective in developing countries. In addition, they have been associated with a slight risk of intussusception, and the need for cold chain maintenance limits the accessibility of these vaccines to certain areas, leaving 65% of children worldwide unvaccinated and therefore unprotected. Against this backdrop, here we review the main vaccines under development and the state of the art on potential alternatives.

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Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-038520 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038520

Author(s):

Maria Lisa Odland ◽

Tahir Bockarie ◽

Haja Wurie ◽

Rashid Ansumana ◽

Joseph Lamin ◽

...

Keyword(s):

Risk Factors ◽

Access To Care ◽

Sierra Leone ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Health System Strengthening ◽

Low Income Countries

IntroductionPrevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.MethodsThis study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.ResultsOf 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.ConclusionsIn Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.

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Descending Necrotising Mediastinitis: A Case Report Illustrating a Trend in Conservative Management

Case Reports in Otolaryngology ◽

10.1155/2012/504219 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

B. A. P. Jayasekera ◽

O. T. Dale ◽

R. C. Corbridge

Keyword(s):

Case Report ◽

Mortality Rate ◽

Surgical Intervention ◽

Case Series ◽

Ct Scanning ◽

Posterior Mediastinum ◽

Chest Drain ◽

Conservative Approach ◽

Computed Tomographic ◽

Contrast Enhanced

The mortality rate from descending necrotising mediastinitis (DNM) has declined since its first description in 1938. The decline in mortality has been attributed to earlier diagnosis by way of contrast-enhanced computed tomographic (CT) scanning and aggressive surgical intervention in the form of transthoracic drainage. We describe a case of DNM with involvement of anterior and posterior mediastinum down to the diaphragm, managed by cervicotomy and transverse cervical drainage with placement of corrugated drains and a pleural chest drain, with a delayed mediastinoscopy and mediastinal drain placement. We advocate a conservative approach with limited debridement and emphasis on drainage of infection in line with published case series.

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High-Amplitude Atlantic Hurricanes Produce Disparate Mortality in Small, Low-Income Countries

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2016.62 ◽

2016 ◽

Vol 10 (6) ◽

pp. 832-837 ◽

Cited By ~ 3

Author(s):

Caleb Dresser ◽

Jeroan Allison ◽

John Broach ◽

Mary-Elise Smith ◽

Andrew Milsten

Keyword(s):

Mortality Rate ◽

Low Income ◽

Negative Binomial ◽

High Amplitude ◽

Low Income Countries ◽

Population Exposure ◽

Storm Events ◽

Per Capita Gdp ◽

Small Countries ◽

Per Capita

AbstractObjectivesHurricanes cause substantial mortality, especially in developing nations, and climate science predicts that powerful hurricanes will increase in frequency during the coming decades. This study examined the association of wind speed and national economic conditions with mortality in a large sample of hurricane events in small countries.MethodsEconomic, meteorological, and fatality data for 149 hurricane events in 16 nations between 1958 and 2011 were analyzed. Mortality rate was modeled with negative binomial regression implemented by generalized estimating equations to account for variable population exposure, sequence of storm events, exposure of multiple islands to the same storm, and nonlinear associations.ResultsLow-amplitude storms caused little mortality regardless of economic status. Among high-amplitude storms (Saffir-Simpson category 4 or 5), expected mortality rate was 0.72 deaths per 100,000 people (95% confidence interval [CI]: 0.16–1.28) for nations in the highest tertile of per capita gross domestic product (GDP) compared with 25.93 deaths per 100,000 people (95% CI: 13.30–38.55) for nations with low per capita GDP.ConclusionsLower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations. (Disaster Med Public Health Preparedness. 2016;10:832–837)

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Febrile Seizures and Measles-Containing Vaccines in China: A Self-Controlled Case Series Study

Vaccines ◽

10.3390/vaccines9101073 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1073

Author(s):

Lu Xu ◽

Ning Li ◽

Liang Zhang ◽

Rui Ma ◽

Ting Fang ◽

...

Keyword(s):

Low Income ◽

Control Period ◽

Case Series ◽

Febrile Seizures ◽

Vaccination Schedule ◽

World Health ◽

Low Income Countries ◽

Case Series Study ◽

Series Study ◽

Observation Period

Little is known about the risk of febrile seizures (FS) after vaccination with measles-containing vaccines (MCVs) in middle- and low-income countries. This self-controlled case series study aimed to evaluate the risk of FSs in Chinese children using data from the Ningbo Regional Health Information Platform. The observation period was 0–12 and 13–24 months of age for the MR and MMR vaccines, respectively. The relative incidences (RIs) within 0–6 days, 7–13 days, 14–27 days, and 28–42 days after vaccination with MCVs were estimated. The remaining observation period was the control period. The RIs within 0–6 days, 7–13 days, 14–27 days, and 28–42 days after MR vaccination were 1.11 [95% confidence interval (CI) 0.33 to 3.70], 0.80 (95% CI 0.23 to 2.86), 1.67 (95% CI 0.81 to 3.42), and 1.02 (95% CI 0.49 to 2.14), respectively. The corresponding RIs after MMR vaccination were 0.99 (95% CI 0.56 to 1.75), 1.17 (95% CI 0.68 to 2.01), 0.87 (95% CI 0.54 to 1.39), and 0.85 (95% CI 0.54 to 1.34), respectively. This study suggests that China’s vaccination schedule for MCVs, as suggested by the World Health Organization (WHO) for countries with a high risk of measles mortality and ongoing transmission, does not increase the risk of FSs.

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Evidence favoring the efficacy of convalescent plasma for COVID-19 therapy

10.1101/2020.07.29.20162917 ◽

2020 ◽

Cited By ~ 10

Author(s):

Stephen A. Klassen ◽

Jonathon W. Senefeld ◽

Patrick W. Johnson ◽

Rickey E. Carter ◽

Chad C. Wiggins ◽

...

Keyword(s):

Patient Outcome ◽

Clinical Trials ◽

Case Report ◽

Mortality Rate ◽

Therapeutic Agent ◽

Randomized Clinical Trials ◽

Matched Control ◽

Case Series ◽

Outcome Data ◽

Control Case

AbstractTo determine the effect of COVID-19 convalescent plasma on mortality, we aggregated patient outcome data from randomized clinical trials (RCT), matched-control, case series, and case report studies. Random-effects analyses of RCT data demonstrated that hospitalized COVID-19 patients transfused with convalescent plasma exhibited a lower mortality rate compared to patients receiving standard treatments. These data provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized COVID-19 patients.

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Utilizing Chair Massage to Address One Woman’s Health in Rural Ghana West Africa: a Case Report

International Journal of Therapeutic Massage & Bodywork Research Education & Practice ◽

10.3822/ijtmb.v9i4.330 ◽

2016 ◽

Vol 9 (4) ◽

pp. 22

Author(s):

Cathy J. Meryanos, LMT, AAS

Keyword(s):

Case Report ◽

Low Income ◽

Access To Health Care ◽

Low Income Countries ◽

Health Concern ◽

Rural Villages ◽

Rural Ghana ◽

Access To Health ◽

Rehabilitative Services ◽

The Right

Background and Objectives: There is limited access to health care in rural Ghana and virtually no rehabilitative services available. This situation presents a unique opportunity to utilizechair massage in addressing women’s health in rural Ghana, particularly when it comes to muscle pain and fatigue from heavy labor. The objective of this case report is to determine the results of chair massage as a strategy to reduce neck, shoulder, and back pain, while increasing range of motion.Case Presentation: The patient is a 63-year old Ghanaian female, who was struck by a public transport van while carrying a 30–50 pound load on her head, two years prior. The accident resulted in a broken right humerus and soft tissue pain. A traditional medicine practitioner set the bone, however there was no post-accident rehabilitation available. At the time of referral, she presented complaints of shoulder, elbow, and wrist pain. In addition, she was unable to raise her right hand to hermouth for food intake.Results: The results of this case report include an increase in range of motion, as well as elimination of pain in the right shoulder, elbow, and hand. Visual assessments showed an approximate increase of ROM within the ranges of 45–65 degrees in the right arm, as well as 10–15 degrees in 4th and 5th fingers. There was also a decrease in muscle hypertonicity in the thoracic and cervical areas, and a profound increase in quality of life for the patient.Discussion: This case report illustrates how therapeutic chair massage was utilized to address a common health concern for one woman in rural Ghana. It also demonstrates that pre-existing musculoskeletal disorders and pain may be eliminated with massage intervention. Massage therapy may be important to ameliorating certain types of health problems in remote rural villages in low income countries.

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