Building leadership capacity and future leaders in operational research in low-income countries: why and how?

Very limited operational research (OR) emerges from programme settings in low-income countries where the greatest burden of disease lies. The price paid for this void includes a lack of understanding of how health systems are actually functioning, not knowing what works and what does not, and an inability to propose adapted and innovative solutions to programme problems. We use the National Tuberculosis Control Programme as an example to advocate for strong programme-level leadership to steer OR and build viable relationships between programme managers, researchers and policy makers. We highlight the need to create a stimulating environment for conducting OR and identify some of the main practical challenges and enabling factors at programme level. We focus on the important role of an OR focal point within programmes and practical approaches to training that can deliver timely and quantifiable outputs. Finally, we emphasise the need to measure successful OR leadership development at programme level and we propose parameters by which this can be assessed. This paper 1) provides reasons why programmes should take the lead in coordinating and directing OR, 2) identifies the practical challenges and enabling factors for implementing, managing and sustaining OR and 3) proposes parameters for measuring successful leadership capacity development in OR

Confronting TB/HIV in the era of increasing anti-TB drug resistance

HIV associated TB is a major public health problem. In 2006, it was estimated that there were over 700,000 people who suffered from HIV associated TB, of whom about 200, 000 have died. The burden of HIV associated TB is greatest in Sub-Saharan Africa where the TB epidemic is primarily driven by HIV. There has been steady progress made in reducing the burden of HIV in TB patients with an increasing number of TB patients tested for HIV and provided with cotrimoxazole preventive therapy (CPT) and anti-retroviral treatment (ART). Less progress is being made to reduce the burden of TB in people living with HIV. The number of HIV infected persons reported to have been screened for TB was less than 1% while Isoniazid preventive therapy was reported to have been provided to less than 0.1% of eligible persons in 2006. A major push is urgently needed to accelerate the implementation of three important interventions. The three are Intensified TB Screening (ICF) among people living with HIV, the provision of Isoniazid Preventive Therapy (IPT) and TB Infection Control(IC). These interventions are best carried out by HIV control programmes which should therefore be encouraged to take greater responsibility in implementing these interventions

Institutional factors associated with effective cardiopulmonary resuscitation among health workers at a County Referral Hospital in Kenya

BACKGROUNDCardiopulmonary resuscitation (CPR) is a very critical practise in the healthcare setting. WHO recommends CPR be initiated within the first three(3) minutes of an arrest. By 2015, mortalities related to cardiac arrest were estimated to be 300, 000 to 370 000 annually[1]. AIMThis study aimed to assess the above factors at a County Referral Hospital in Kenya. METHODOLOGYA descriptive cross-sectional design was adopted with a permission from the Institution to collect data. A total of 175 health care providers aged between 18-39 years and had served at the Nakuru County Referral Hospital for more than 6 months participated in the study. Students and staff on internship were excluded. Self- administered questionnaires were used. To gurantee their validity and checklists were practical, a pre-test was done at Thika Level 5 hospital since it shared the same characteristics. Ambiguous questions were rephrased. Data analysis was done using SPSS computer software, version 24 while demographic data were analysed by descriptive statistics. RESULTSThe study reported inadequate staffing. The response was 92.5% with a majority 69.1 %( n=112) being females. Basically (89.5%) of them were nurses, a profession where females are the majority. Respondents 18-29 years were 36.4% (n=59) while those aged between 30 and 39 years accounted for 32.1%(n=52). The mean age was 32 years. The vast majority of respondents were young (<40 years). Some respondents (51.9% (N=81), indicated that, they did not have all the necessary resources for CPR. Having a BLS/ACLS certificate (p=0.042), a refresher course in the last 2 years (p=0.029) and necessary resources (p=0.034) was significant. All respondents had the minimum required level of education for their profession, ie, 52.8% (n=85) had acquired a diploma in nursing while 31.7% (n=51) had a bachelor's degree. All cadres of health workers participated spreading out across the various departments at the study site. The medical ward had 25.9% (n=42) while 24.7% (n=40) worked in the surgical ward. CONCLUSIONThe study Confirmed that, institutional factors influence effective Cardiopulmonary Resuscitation. Effective CPR improves the patients' outcomes reducing mortality related to cardiac arrest (CA). Early detection of cardiopulmonary arrest and initiation of CPR greatly influence the outcomes of CPR. Lack of debriefing following CPR among Health workers contribute to ineffective and repeated mistakes when conducting CPR. Understaffing in the hospital setting limits the number of personnel who assist in the practice. The fatigue experienced by the rescuer prevents optimal chest compression. The sub-Saharan region lack documented information to enlighten the public about the problem. RECOMMENDATIONHospital administrators should guarantee the provision of both human and material resources. Policy makers aught come up with policies to ensure that, all staff members are trained on CPR protocols

Advancing new diagnostic tests for latent tuberculosis infection due to multidrug-resistant strains of Mycobacterium tuberculosis - End of the road?

An estimated 1.8 billion people worldwide have a latent tuberculosis infection (LTBI), with wide variations in LTBI rates across countries. LTBI can be due to infection with either drug-sensitive or drug-resistant Mycobacterium tuberculosis (Mtb) strains. Accurate data on the prevalence of LTBI due to multidrug-resistant (MDR) Mtb strains are unavailable, since the strains cannot be isolated for resistance testing. There are no 'gold standard' tests for accurately diagnosing LTBI. Only three tests are currently available and approved by the World Health Organization (WHO) for the diagnosis of LTBI: the now outdated tuberculin skin test (TST), developed a century year ago, and the two interferon-gamma release assays (IGRAs) developed and rolled out over the past decade, the QuantiFERON (Qiagen, Germany) and T-SPOT.TB (Oxford Immunotec, United Kingdom) tests. These latter tests are not ideal due to issues of sensitivity, specificity, inability to distinguish infection with MDR-Mtb strains, and high costs. Achieving the WHO End TB Strategy target of an 80% reduction in global TB incidence by 2030 will require a major reduction in the number of persons with LTBI progressing to active TB disease. Critical to this will be the development of new diagnostic tests that are better than currently available LTBI tests at predicting who is at risk of progression to active TB disease. The diagnostic product development portfolio for LTBI appears to have reached the end of the road. Every attempt to make optimal use of currently available IGRAs using WHO LTBI guidelines for LTBI testing and treatment must be made to achieve WHO End TB strategy targets

Bacille Calmette-Guérin (BCG) vaccine and potential cross-protection against SARS-CoV-2 infection - Assumptions, knowns, unknowns and need for developing an accurate scientific evidence base

After a century of controversies on its usefulness in protection against TB, underlying mechanisms of action, and benefits in various groups and geographical areas, the BCG vaccine is yet again a focus of global attention- this time due to the global COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Recent studies have shown that human CD4+ and CD8+ T-cells primed with a BCG-derived peptide developed high reactivity to its corresponding SARS-CoV-2-derived peptide. Furthermore, BCG vaccine has been shown to substantially increase interferon-gamma (IFN-g) production and its effects on CD4+ T-cells and these non-specific immune responses through adjuvant effect could be harnessed as cross protection against severe forms of COVID-19.The completion of ongoing BGG trials is important as they may shed light on the mechanisms underlying BCG-mediated immunity and could lead to improved efficacy, increased tolerance of treatment, and identification of other ways of combining BCG with other immunotherapies

Asthma care in sub-Saharan Africa: Mind the gap!

No abstract

Short-acting β2-agonist prescription patterns for asthma management in the SABINA III primary care cohort

CKNOWLEDGEMENTS AstraZeneca funded all the SABINA studies and was involved in designing the study, developing the study protocol, conducting the study and performing the analyses. AstraZeneca was given the opportunity to review the manuscript before submission and funded medical writing support. Writing and editorial support was provided in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3) and fully funded by AstraZeneca.Peer reviewedPublisher PD