Sepsis in Africa: practical steps to stem the tide

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

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

Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study

Background: The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa. Methods: We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease. Results: Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola. Conclusions: The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa