Non-Communicable Disease and Diabetes Screening in Community Settings in Low- and Middle-Income Countries: A Case Study in Senegal, West Africa

Sub-Saharan Africa is faced with a significant and increasing burden of non-communicable diseases such as type 2 diabetes mellitus (diabetes). In Senegal, the prevalence of diabetes has been documented to be as high as 8.1% in urban-dwelling Senegalese and is fast approaching the United States prevalence of approximately nine percent; however, insufficient resources are available for prevention efforts and disease management. As a result, many cases remain undiagnosed, leading to an increased likelihood of diabetes complications and mortality. Many of these cases remain undiagnosed or are diagnosed only after complications have developed, such as the need for amputation, kidney failure, or loss of vision, which could be potentially reduced through diabetes self-management support. In addition, factors such as limited access to adequate facilities for screening and treatment lead to a disproportionate burden of diabetes related morbidity and mortality in this context. While early detection is a necessity, ethical and logistical considerations should be explored in order to inform and deliver culturally grounded, sustainable, and accessible diabetes screening. We discuss the use of community-based health fairs for diabetes screening and present a case study of a free screening program used in Senegal, West Africa

Diabetes in Senegal

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A descriptive study of trauma cases encountered in the Grand M’Bour Hospital Emergency Department in Senegal

Introduction: this study analyzed the trends of trauma cases that presented to the Emergency Department (ED) in the Grand M'Bour Hospital. We examined demographics of patients, mechanisms of trauma and types of injuries that result and times from injury to arrival. Methods: this was a descriptive study using prospective ED trauma cases. Patients were selected for the study if their chief complaint was related to a traumatic injury. A trauma flow sheet was developed to obtain information. Data was collected from 6/22/16-7/13/16, with 105 cases recorded. Abstracted data included date, time of arrival, time of injury, age, gender, mechanism of injury, injury sustained and disposition. Results: patients presented to the ED for 13 different trauma-related reasons. 71% of the patients encountered had a mechanism of injury related to falls or motor vehicle accidents. The majority of patients who suffered from a fall-or motor vehicle-related injury were children, with ages 0-10 representing 31% and ages 11-20 representing 14% of the total patients. While 29% of patients were seen within 1 hour of the time of their injury, 10% of the patients were not seen until days after their injury. Conclusion: we report that traumatic injuries are most commonly a result of fall-related and vehicle-related accidents. Children under the age of 20 years old are a vulnerable population for traumatic injuries. We observed that many patients were unable to seek care within a day of their injury. This was concerning that proper emergency transportation was not available, leading to potential complications or improper healing of injuries. Knowing these trends, an ED can be better prepared to treat these patients

Unpreparedness and uncertainty: a qualitative study of African American experiences during COVID-19 pandemic

During disasters, vulnerable populations are disproportionately affected. COVID-19 disproportionately affected African American (AA) families, increasing their risk for COVID-19 morbidity and mortality. The pandemic also exacerbated existing negative milieu such as economic opportunity and access to social and healthcare services. We explored AA families’ experiences of indirect pandemic effects. Data were collected through semi-structured in-depth telephone interviews with 11 AA parent/grandparents of school-aged child (5–17 years). Line-by-line coding and thematic analysis were used to analyze and interpret the data. Three emergent themes highlighted the salient indirect effects of COVID-19 pandemic on AA families: (i) access to healthcare, (ii) access to food, and (iii) disaster unpreparedness. Participants expressed frustration with virtual healthcare services and inability to schedule in-person hospital appointments for health conditions unrelated to COVID-19. Lack of food products in stores and limited financial resources due to pandemic-related job layoffs were important food insecurity factors discussed. Unpreparedness on the part of institutions, state, and the nation, created heightened perceptions of vulnerability. Given the social vulnerability spectrum in the U.S., pandemic planning approaches that promote equity are critical if public officials are to develop effective adaptation, mitigation, response, and recovery plans that mobilize and serve diverse populations

Global Health Collaboration: Challenges and Lessons

This stimulating open access volume details the innovative work of the Pan Institution Network for Global Health in creating collaborative research-based answers to large-scale health issues. Equitable partnerships among member universities representing North America, Africa, Asia, and Europe reverse standard cross-national dynamics to develop locally relevant responses to health challenges as well as their underlying disparities. Case studies focusing on multiple morbidities and effects of urbanization on health illustrate open dialogue in addressing HIV, maternal/child health, diabetes, and other major concerns. These instructive examples model collaborations between global North and South as meaningful steps toward the emerging global future of public health. Included in the coverage: Building sustainable networks: introducing the Pan Institution Network for Global Health Fostering dialogues in global health education: a graduate and undergraduate approach Provider workload and multiple morbidities in the Caribbean and South Africa Project Redemption: conducting research with informal workers in New York City Partnership and collaboration in global health: valuing reciprocity Global Health Collaboration will interest faculty working within the field of global health; scholars within public health, health policy, and cognate disciplines; as well as administrators looking to develop international university partnerships around global health and graduate students in the areas of global health, health administration, and public health and related social sciences (e.g., sociology, anthropology, demography)

Evaluation of the Community Child Health Research Network (CCHN) Community-Academic Partnership

Background: The Community Child Health Network (CCHN) is a research collaborative network of five communities in the U.S. formed to study maternal and child health disparities, via a community-based participatory research study design. CCHN studies how community, family, and individual level influences interact with biological processes to affect maternal stress, resilience, and allostatic load; ultimately, the study evaluates whether such factors result in health disparities in pregnancy outcomes and infant and early childhood mortality and morbidity. The purpose of this paper is to assess the community-based participatory research (CBPR) process that governs the CCHN and offer lessons from our experiences. Methods: This study employs a qualitative approach to evaluate the CBPR process among CCHN community and academic partners. Qualitative interviews (n=17) were completed by both community and academic CCHN partners. Results: Content analysis of qualitative data revealed six major themes (1) lack of necessary resources; (2) collaborative learning; (3) perceived benefits; (4) communication and education; (5) trust and expectations; and (6) sustainability. Discussion: The benefits and challenges of implementing productive, community-academic partnerships were present both at the local site-level and the network-level. Ultimately, the inclusion of community-based participatory research principles and methods enhanced the study development, implementation, analysis, and dissemination of findings. Conclusion: Lessons learned from a multi-site CBPR project, including strategies for managing learning and communication across different geographic sites, may be useful to other CBPR and multi-site community-based research endeavors

A community-based participatory research project to increase the understanding of the health concerns of African immigrant communities in urban Missouri.

Background African immigrants and refugees experience unique mental and physical health care needs that may be a result of pre-migration history and the acculturation process. The purpose of this project was to collaborate with African immigrant and refugee communities to identify health needs of the communities and lay a foundation for future action. Methods Key-informant interviews with five West, East and Central African immigrant and refugee communities included community leaders (n=10) and listening sessions with larger groups of community members totaling approximately 150 participants to identify health care needs. Content analysis was employed to identify themes related to immigrant and refugee health. Results Meetings with community leaders and members were conducted at community venues often immediately following or during a planned event. Six general themes emerged: mental health/trauma; sexual health; nutrition; chronic disease prevention; insurance coverage; and youth empowerment. Discussion Chronic mental and physical health issues were of primary concern. One key lesson learned in building successful partnerships was having members of the research team who were born into partnering African immigrant and refugee communities and were passionate about working with their communities

Health service access across racial/ethnic groups of children in the child welfare system

This study examined health service access among children of different racial/ethnic groups in the child welfare system in an attempt to identify and explain disparities

Sink or swim: Virtual life challenges among African American families during COVID-19 lockdown

This study explores African American parents’ experiences with using technology toengage their children in meaningful activities (e.g., e-learning) during COVID-19 and its impact on family health. Eleven African American families were recruited through a local health department program from a rural Midwestern community to participate in semi-structured interviews. The majority of participants reported stresses from feelings of “sink or swim” in a digital world, without supports from schools to effectively provide for their children’s technology needs. The COVID-19 pandemic underscored the importance of family-school collaborative engagement and empowerment. Digital technology needs to become part of our school education system so that technology use among African Americans is elevated and families protected against future outbreaks. Further research with a more diverse African American sample is needed

Evaluation of a Breast Cancer Screening Program in Nigeria using the Evaluability Assessment Model

There exists a paucity of policies and programs that support breast cancer screening in Nigeria. There is a clear need for effective programs that are cognizant of the local realities in Nigeria. The evaluability assessment model can be used as a cost effective and quick alternative to traditional evaluations to improve program practices and management and develop performance measures. This study uses an evaluability assessment to determine if a breast cancer screening program in Lagos, Nigeria was achieving its objectives and to adjust their activities to improve outcomes and processes to optimally serve its community. The evaluability assessment revealed the programs objectives are plausible given its resources and context. Program recommendations focused on improving staff management, developing benchmarks to measure outputs and outcomes, and examining more effective methods of disseminating program information to target population. This study is used as an example of how the six-step evaluability assessment model can be adapted to a multitude of programs to appraise program practices or performance measures