Sepsis in Africa: practical steps to stem the tide

<I>Pan African Medical Journal</I> 2015; 2

One country, two crises: what Covid-19 reveals about health inequalities among BAME communities in the United Kingdom and the sustainability of its health system?

There has been mounting evidence of the disproportionate involvement of black, Asian and minority ethnic (BAME) communities by the Covid-19 pandemic. In the UK, this racial disparity was brought to the fore by the fact that the first 11 doctors to die in the UK from Covid-19 were of BAME background. The mortality rate from Covid-19 among people of black African descent in English hospitals has been shown to be 3.5 times higher when compared to rates among white British people. A Public Health England report revealed that Covid-19 was more likely to be diagnosed among black ethnic groups compared to white ethnic groups with the highest mortality occurring among BAME persons and persons living in the more deprived areas. People of BAME background account for 4.5% of the English population and make up 21% of the National Health Service (NHS) workforce. The UK poverty rate among BAME populations is twice as high as for white groups. Also, people of BAME backgrounds are more likely to be engaged in frontline roles. The disproportionate involvement of BAME communities by Covid-19 in the UK illuminates perennial inequalities within the society and reaffirms the strong association between ethnicity, race, socio-economic status and health outcomes. Potential reasons for the observed differences include the overrepresentation of BAME persons in frontline roles, unequal distribution of socio-economic resources, disproportionate risks to BAME staff within the NHS workspace and high ethnic predisposition to certain diseases which have been linked to poorer outcomes with Covid-19. The ethnoracialised differences in health outcomes from Covid-19 in the UK require urgent remedial measures. We provide intersectional approaches to tackle the complex racial disparities which though not entirely new in itself, have been often systematically ignored

Surface diffusion induced by low-energy bombardment with He ions: an exchange mechanism

The radiation-induced surface diffusion of molybdenum adatoms was studied using molecular dynamics simulations based on a many-body tight-binding potential interpolated to the short-range repulsive screened Coulombic interactions. It was shown that the He ion impact is accompanied by an extensive surface mobility of Mo atoms. The long radiation-induced atomic jumps, spanning more than a nearest-neighbor distance, were revealed on the {110} terrace. The radiation induced exchange of Mo atoms colliding with Mo {110} surface was found in our mathematical simulations: there were observed exchange processes in which the radiation excited atom entered the surface and another surface atom emerged nearby. These results of MD simulations appear to be the first observation of exchange events in radiation-induced surface diffusion.Радіаційно-індукована поверхнева дифузія адатомів молібдену була вивчена за допомогою моделювання методом молекулярної динаміки, що базується на багаточастковому потенціалі жорсткого зв'язку з інтерполяцією короткодіючого відштовхування екранованою кулонівською взаємодією. Було показано, що бомбардування іонами Не супроводжується великою поверхневою рухливістю атомів Мо. Довгі радіаційно-індуковані атомні стрибки, що охоплюють відстані більш, ніж найближчі міжатомні, були виявлені на {110} терасах. Радіаційно-індукований обмін атомів Мо, що стикаються з поверхнею Мо {110}, був виявлений в нашому математичному моделюванні: спостерігалися обмінні процеси, в яких радіаційно-збуджений атом проникав у поверхневий шар, а поблизу виходив на поверхню інший атом. Ці результати моделювання являють собою перше спостереження обмінних ефектів у радіаційно-індукованій поверхневій дифузії.Радиационно-индуцированная поверхностная диффузия адатомов молибдена была изучена с помощью моделирования методом молекулярной динамики, основанном на многочастичном потенциале жесткой связи с интерполяцией короткодействующего отталкивания экранированным кулоновским взаимодействием. Было показано, что бомбардировка ионами Не сопровождается обширной поверхностной подвижностью атомов Мо. Длинные радиационно-индуцированные атомные скачки, охватывающие расстояния более чем ближайшие межатомные, были выявлены на {110} террасах. Радиационно-индуцированный обмен атомов Мо, сталкивающихся с поверхностью Мо {110}, был обнаружен в нашем математическом моделировании: наблюдались обменные процессы, в которых радиационно-возбужденный атом проникал в поверхностный слой, а поблизости выходил на поверхность другой атом. Эти результаты моделирования представляют собой первое наблюдение обменных эффектов в радиационно-индуцированной поверхностной диффузии

Strengthening primary healthcare through community involvement in Cross River State, Nigeria: a descriptive study

Introduction: In preparation for implementation of primary healthcare (PHC) services in Cross River State, a study to identify perceptions of communities and health systems concerning such interventions was conducted. Methods: Existing PHC practices were documented through observation and document reviews, including facility checklists at frontline levels. Perceptions of consumers and providers on PHC were elucidated through 32 Focus Group Discussions (FGDs) and 78 semi-structured questionnaires. Results: There was some level of implementation of the Nigerian PHC policy in the study districts. However, this policy emphasized curative instead of preventive services. Private partners perceived healthcare programmes as largely donor driven with poor release of allocations for health by government. Conclusion: Both providers and consumers presented similar perceptions on the current PHC implementation and similar perspectives on services to be prioritized. These common views together with their on-going participatory experience are important platforms for strengthening community participation in the delivery of PHC.Key words: Primary Health Care, Community directed Interventions, key informant interviews, focus group discussions, Cross River Stat

Treatment of Histoplasmosis

Histoplasmosis, caused by the thermally dimorphic fungus Histoplasma capsulatum, is an uncommon multisystem disease with a global distribution. The spectrum of clinical manifestations ranges from an asymptomatic or minimally symptomatic acute pulmonary disease following inhalation of a large inoculum of Histoplasma microconidia to chronic pulmonary disease in patients with underlying structural lung disease. It also extends to acute progressive disseminated disease in patients with severe immunodeficiency. Generally, antifungal therapy is indicated for patients with progressive acute pulmonary histoplasmosis, chronic pulmonary histoplasmosis and acute progressive disseminated histoplasmosis. In immunocompetent patients, acute pulmonary histoplasmosis may be a self-limiting disease without the need for systemic antifungal therapy. Oral triazole antifungal drugs alone are recommended for less severe disease. However, moderate-to-severe acute pulmonary histoplasmosis requires intravenous amphotericin B therapy for at least 1–2 weeks followed by oral itraconazole for at least 12 weeks. For acute progressive disseminated histoplasmosis, intravenous amphotericin B therapy is given for at least 2 weeks (4–6 weeks if meningeal involvement) or until a patient can tolerate oral therapy, followed by oral itraconazole (or an alternative triazole) for at least 12 months. Chronic cavitary pulmonary histoplasmosis is treated with oral itraconazole for 1–2 years. There is insufficient evidence to support the use of isavuconazole or the echinocandins for the treatment of histoplasmosis

mHealth guideline training for non-communicable diseases in primary care facilities in Nigeria: a mixed methods pilot study

From BMJ via Jisc Publications RouterHistory: received 2021-12-19, accepted 2022-07-12, ppub 2022-08, epub 2022-08-26Publication status: PublishedFunder: UK National Institute for Health Research (NIHR) [NIHR Global Health Research programme /NIHR Research Unit on Health in Situations of Fragility].; Grant(s): 16/136/100Objective: To pilot the use of a scalable innovative mobile health (mHealth) non-communicable diseases (NCDs) training application for nurses at the primary care level. Design: Mixed methods pilot of mHealth training on NCD care for nurses at primary healthcare (PHC) facilities. We provide a descriptive analysis of mHealth training test scores, with trend analysis of blood pressure (BP) control using paired t-test for quantitative data and thematic analysis for qualitative data. Setting: PHC facilities in rural and urban communities in Cross River State, south eastern Nigeria. NCDs were not part of routine training previously. As in most low-and-middle-income settings, funding for scale-up using conventional classroom in-service training for NCDs is not available in Nigeria, and onsite supervision poses challenges. Participants: Twenty-four health workers in 19 PHC facilities. Intervention: A self-paced mHealth training module on an NCD desk guide was adapted to be applicable within the Nigerian context in collaboration with the Federal Ministry of Health. The training which focused on hypertension, diabetes and sickle cell disease was delivered via Android tablet devices, supplemented by quarterly onsite supervision and group support via WhatsApp. The training was evaluated with pre/post-course tests, structured observations and focus group discussions. This was an implementation pilot assessing the feasibility and potential effectiveness of mHealth training on NCD in primary care delivery. Results: Nurses who received mHealth training recorded a statistically significant difference (p<0.001) in average pretest and post-test training scores of 65.2 (±12.2) and 86.5 (±7.9), respectively. Recordings on treatment cards indicated appropriate diagnosis and follow-up of patients with hypertension with significant improvements in systolic BP (t=5.09, p<0.001) and diastolic BP (t=5.07, p<0.001). The mHealth nurse training and WhatsApp support groups were perceived as valuable experiences and obviated the need for face-to-face training. Increased workload, non-availability of medications, facility-level conflicts and poor task shifting were identified challenges. Conclusions: This initiative provides evidence of the feasibility of implementing an NCD care package supported by mHealth training for health workers in PHCs and the strong possibility of successful scale-up nationally

Implementing health worker training on sepsis in South Eastern Nigeria using innovative digital strategies: an interventional study

Background: Sepsis is a leading cause of morbidity and mortality especially in low- and middle-income countries such as Nigeria. Training of health workers using digital platforms may improve knowledge and lead to better patient outcomes. Objectives: To assess the effectiveness of a digital health educational module on sepsis in improving the knowledge of medical doctors in Cross River State Nigeria on the diagnosis and management of patients presenting with sepsis. Design: Quasi-experimental analytical study. Methods:: We developed and deployed a sepsis module through an innovative application (Sepsis tutorial app) to doctors in Calabar, Nigeria. We assessed quantitative pre- and post-intervention knowledge scores for those completing the tutorial on sepsis between both assessments. A user satisfaction survey evaluated the content of the tutorial and the usability of the app. Results:: One hundred and two doctors completed the course. There were more males than females (58.8% versus 41.2%). Over half (52%) were junior doctors, a minority were general practitioners and house officers (3% and 5%, respectively), and 72.6% had practiced for periods ranging from 1 to 15 years post-qualification. Gender and age appeared to have no significant association with pre- and post-test scores. The oldest age group (61–70) had the lowest mean pre- and post-test scores, while general practitioners had higher mean pre- and post-test scores than other cadres. The majority (95%) of participants recorded higher post-test than pre-test scores with a significant overall increase in mean scores (25.5 ± 14.7%, p < 0.0001). Participants were satisfied with the content and multimodal delivery of the material and found the app usable. Conclusion:: Digital training using context-responsive platforms is feasible and may be used to close the critical knowledge gap required to respond effectively to medical emergencies such as sepsis in low- to middle-income settings

Nature-based One Health approaches to urban agriculture can deliver food and nutrition security

peer reviewedThe increasing global human population is projected to reach 9.7 billion people by 2050. This population growth is currently linked to the trends of world-wide urbanization, growth of megacities and shifting dietary patterns. While humankind faces the daunting challenge of feeding and providing healthy lives for its teeming populations, urban agriculture holds promise for improving the quality of life in cities. Fortunately, policymakers and planners are accepting the need to support urban fringe farmers to increase the resilience of food systems while efficiently managing already strained natural resources. We argue that for urban agriculture to significantly increase food yields, it is crucial to adopt a One Health approach to agriculture and environmental stewardship. Here, we propose six nature-based and climate-smart approaches to accelerate the transition towards more sustainable food systems. These approaches include reducing the reliance on synthetic agricultural inputs, increasing biodiversity through producing locally adapted crops and livestock breeds, using probiotics and postbiotics, and adopting portable digital decision support systems. Such radical approaches to transforming food production will require cross-sectoral stakeholder engagement at international, national, and community levels to protect biodiversity and the environment whilst ensuring sustainable and nutritious diets that are culturally acceptable, accessible, and affordable for all.1. No poverty2. Zero hunger3. Good health and well-being10. Reduced inequalities11. Sustainable cities and communities12. Responsible consumption and production13. Climate action17. Partnerships for the goal