Establishing and operating a 'virtual ward' system to provide care for patients with COVID-19 at home: experience from The Gambia.

Health systems in sub-Saharan Africa have remained overstretched from dealing with endemic diseases, which limit their capacity to absorb additional stress from new and emerging infectious diseases. Against this backdrop, the rapidly evolving COVID-19 pandemic presented an additional challenge of insufficient hospital beds and human resource for health needed to deliver hospital-based COVID-19 care. Emerging evidence from high-income countries suggests that a 'virtual ward' (VW) system can provide adequate home-based care for selected patients with COVID-19, thereby reducing the need for admissions and mitigate additional stress on hospital beds. We established a VW at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, a biomedical research institution located in The Gambia, a low-income west African country, to care for members of staff and their families infected with COVID-19. In this practice paper, we share our experience focusing on the key components of the system, how it was set up and successfully operated to support patients with COVID-19 in non-hospital settings. We describe the composition of the multidisciplinary team operating the VW, how we developed clinical standard operating procedures, how clinical oversight is provided and the use of teleconsultation and data capture systems to successfully drive the process. We demonstrate that using a VW to provide an additional level of support for patients with COVID-19 at home is feasible in a low-income country in sub-Saharan Africa. We believe that other low-income or resource-constrained settings can adopt and contextualise the processes described in this practice paper to provide additional support for patients with COVID-19 in non-hospital settings

Intense and Mild First Epidemic Wave of Coronavirus Disease, The Gambia.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is evolving differently in Africa than in other regions. Africa has lower SARS-CoV-2 transmission rates and milder clinical manifestations. Detailed SARS-CoV-2 epidemiologic data are needed in Africa. We used publicly available data to calculate SARS-CoV-2 infections per 1,000 persons in The Gambia. We evaluated transmission rates among 1,366 employees of the Medical Research Council Unit The Gambia (MRCG), where systematic surveillance of symptomatic cases and contact tracing were implemented. By September 30, 2020, The Gambia had identified 3,579 SARS-CoV-2 cases, including 115 deaths; 67% of cases were identified in August. Among infections, MRCG staff accounted for 191 cases; all were asymptomatic or mild. The cumulative incidence rate among nonclinical MRCG staff was 124 infections/1,000 persons, which is >80-fold higher than estimates of diagnosed cases among the population. Systematic surveillance and seroepidemiologic surveys are needed to clarify the extent of SARS-CoV-2 transmission in Africa

Cardiovascular Disease among commercially insured adults with type 1 diabetes in the US , 2016-2019

Objectives: The objective of this study is to examine the overall as well as age- and sex-specific burden of cardiovascular disease (CVD) among adults with type 1 diabetes (T1D) in the US using nationwide commercial claims data from 2016-2019. Research Design and Methods We used nationwide commercial claims data (1/1/2016-12/31/2019) from Merative™MarketScan to identify adults ≥20 years with T1D (ascertained using ICD-10 codes). CVD was ascertained using ICD-10 diagnostic codes for myocardial infarction, atrial fibrillation, ischemic heart disease, heart failure, peripheral arterial disease, and stroke. The annual prevalence and age-specific prevalence of CVD were calculated. Age-adjusted prevalence of CVD by sex and select comorbidities was also calculated and multivariable logistic regression analysis was used to determine associations between sex, prevalent comorbidities, and CVD. Results: The number of people with T1D ranged from 39,134 to 52,133 across the study years (age of 47 (14-16) years; 48% female) and the prevalence of CVD ranged from 15.63% in 2016 to 16.68% in 2019. In 2019, among those aged 20-39 years, 40-64 years, and 65 years and older, the prevalence of CVD was 3.40%, 18.01 %, and 53.62%, respectively. A higher proportion of males had CVD compared to females (18.8% vs. 16.06%). The prevalence of CVD was high in the presence of all comorbidities; the odds of CVD among those with hypertension was 2.58(95%CI-2.39-2.79, nephropathy 2.02(95% CI 1.88-2.18), and neuropathy 2.16(95%CI-2.02-2.31). Conclusion: One-sixth of adults with T1D have CVD; the prevalence of CVD is higher in older age groups, males, and people with comorbidities. This study highlights the need for early screening for, and diagnosis of CVD and comorbidities associated with CVD in this population

Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study.

BACKGROUND: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. METHODS: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. RESULTS: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. CONCLUSION: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately

Knowledge, attitudes and beliefs about the health hazards of biomass smoke exposure amongst commercial food vendors in Nigeria

Background Exposure to biomass smoke is a major cause of morbidity and mortality in Africa. Commercial food vendors in Nigeria and elsewhere in Africa are commonly exposed to biomass smoke from open fire cooking both at work and home. Little is known about the knowledge, attitudes and beliefs of food vendors about the health hazards of biomass smoke exposure in Nigeria. Methods We did a descriptive cross sectional survey of the knowledge, attitudes and beliefs of commercial food vendors in the cities of Benin and Calabar in Nigeria. We recruited respondents using a multi-stage approach. Structured interviewer-administered questionnaires were used for data collection. Results We recruited 308 participants (164, 53.2% female). The majority 185(60.2%) were married and had post-primary education 206(67.4%). The average monthly income was <30,000 Naira (US$150). Most 198(64.4%) were not aware that biomass smoke exposure is harmful to human health. About three-quarters (221; 71.8%) were unconcerned as to the effect of exposure to fumes from biomass fuels on their health. Less than half of respondents (110, 41.6%) believed biomass smoke was harmful to health. Male gender, being single, having post-primary education and preferring electricity or gas fuels were associated with good knowledge of the adverse health effects of biomass smoke exposure whilst female gender and having good knowledge of the adverse health effects of biomass smoke were associated with positive attitudes towards preventing exposure. Conclusion Commercial food vendors in our study had limited knowledge about the adverse health effects of biomass smoke exposure and negative attitudes towards preventing these adverse health effects. We suggest an educational intervention is needed to improve this knowledge

Logistic regression for predictors of knowledge and attitude of food vendors.

<p>Logistic regression for predictors of knowledge and attitude of food vendors.</p

Perception of insulin therapy among patients with type 2 diabetes mellitus in Jos, North Central Nigeria

Background -The implementation of insulin in the management of type 2  diabetes mellitus is often necessary for better glycaemic control. However,  many still consider insulin therapy as the last resort. Several factors come  to play in the acceptance of insulin as a form of therapy by patients. This study evaluated the perception of insulin therapy among patients with type 2 diabetes mellitus.Methods- This was a descriptive cross-sectional study carried out at the Jos University Teaching Hospital (JUTH) Jos, North Central Nigeria. One hundred and eighty five persons (100 insulin naïve persons and 85 persons on  insulin) were recruited consecutively. The insulin treatment appraisal scale (ITAS) was used to evaluate the perception of insulin therapy among these patientsResults- fifty five (64.7%) females were on insulin while 64 (64%) were insulin naïve. The mean age was 52 ± 11 years and 59 ± 10 years in those on insulin and insulin naïve persons respectively. Twenty one (24.7%) persons on insulin and 33 (33%) insulin naïve persons had tertiary level of education. Insulin naïve persons had higher mean total score of the 20 items, total score of the 16 negative items and total score of the 4 positive items compared with persons on insulin. Among persons on insulin, those with less than one year of education had a better perception of insulin therapy compared with persons who had six years or more of education; Duration of insulin use, gender and age had no impact on perception of insulin therapy.Conclusion- The perception of insulin therapy among persons with type 2 diabetes mellitus is poor.Key words-Insulin, insulin treatment appraisal scale, type 2 diabetes mellitus, perception of insulin therap

Food vendor characteristics.

<p>Food vendor characteristics.</p

Bivariate variables for good attitude towards preventing harmful effects of biomass fuel smoke.

<p>Bivariate variables for good attitude towards preventing harmful effects of biomass fuel smoke.</p

Bivariate variables for knowledge of harmful effects of biomass fuel smoke.

<p>Bivariate variables for knowledge of harmful effects of biomass fuel smoke.</p