Skin Diseases Among Sub-Saharan African Prisoners: The Cameroonian Profile

Background: Overcrowding and promiscuity observed in our prisons are a spreading source of several diseases including infections transmitted by interhuman contact. It has been argued that skin diseases are the most frequent reasons for consultations in prisons. In Cameroon, no study has been done to assess the magnitude of this issue. Our study aimed at determining the profile of dermatological pathologies among Cameroonian prison inmates. Methods: This was a cross-sectional study at the Mfou Principal Prison from February to April 2014. Were included all prisoners who consulted the research team at the prison infirmary during the period of recruitment and who accepted to take part in the study. Prisoners were consulted and a structured questionnaire was used for data collection. Diagnosis was based on the anamnestic and clinical findings. Participants with uncertain diagnosis were excluded from the study. Data were entered into Microsoft excel 2010 spreadsheets and analyzed using SPSS version 17.0. Results: A total of 217 prisoners were retained for our study out of the 369 present in the prison during the study period. Among these 217 prisoners, 201 (92.6%) were males, 189 (87.1%) were Christians, 123 (56.7%) did not attend the secondary school, and 137 (63.1%) were single. Age ranged from 14 to 60 years with a mean of 32 ± 4.7 years and, age groups 21-30 and 31-40 being the most represented ones. More than half (57.1%) of our population exhibited skin diseases with scabies being present in 41% of cases. The dominating presentations of skin diseases were: scabies (71.8%), eczema (9.7%), dermatophytosis (specifically tinea corporis: 5.6%), pityriasis versicolor (4.8%), and acne (3.2%). Six point five percent of participants presented with more than one skin disease, and eczema was the most frequent disease associated with scabies in 8 cases (6.4%). Pityriasis versicolor was the most common skin disease among females (25% of women infected). Conclusion: There is a high prevalence of skin diseases among prisoners at the Mfou Principal Prison. of which scabies (71.6%), eczema (9.7%), dermatophytosis (5.6%) and pityriasis versicolor (4.8%) were the prevailing skin diseases encountered .There is thereby an urgent need to implement strong and efficient interventions in order to solve the problems of over population, poor hygiene, precarious quality of life and lack of health care in our prisons

Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia

Background: The antiretroviral treatment (ART) scale-up service has been a recent development in Ethiopia, but its impact on mortality has not been well investigated. The aim of this study was to assess the early survival outcome of the scale-up service by utilizing routine hospital data. Methods: All adult HIV/AIDS patients who started on antiretroviral treatment in Shashemene and Assela hospitals from January 1, 2006 to May 31, 2006 were included and followed up for 2 years. Data were extracted from standard patient medical registrations. Kaplan-Meier curves were used to estimate survival probability and the Cox proportional hazard model was applied to determine predictors of mortality. Two alterative assumptions (real case and worst case) were made in determining predictors of mortality. Results: The median age of patients was 33 years and 57% were female. Eighty-five percent had CD4 <200 cells/mu L with a median CD4 count of 103 cells/mu L. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during the 2-year period and 48 patients (18%) were lost to follow up. The majority of deaths occurred in the first 4 months of treatment. In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions. The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter. Conclusion: The study has shown an overall low mortality but a high loss to follow-up rate of the cohort. Advanced clinical stage, anemia, low body weight, and lack of CPT initiation were independent predictors of mortality - but not gender. CPT initiation should be encouraged in routine HIV care services, and patient retention mechanisms have to be strengthened. Stagnation in immunological and weight recovery after the first 6 months should be further investigated. The utilization of routine data should be encouraged in order to facilitate appropriate decision making

Linkage to HIV Care and Antiretroviral Therapy in Cape Town, South Africa

BACKGROUND: Antiretroviral therapy (ART) has been scaled-up rapidly in Africa. Programme reports typically focus on loss to follow-up and mortality among patients receiving ART. However, little is known about linkage and retention in care of individuals prior to starting ART. METHODOLOGY: Data on adult residents from a periurban community in Cape Town were collected at a primary care clinic and hospital. HIV testing registers, CD4 count results provided by the National Health Laboratory System and ART registers were linked. A random sample (n = 885) was drawn from adults testing HIV positive through antenatal care, sexual transmitted disease and voluntary testing and counseling services between January 2004 and March 2009. All adults (n = 103) testing HIV positive through TB services during the same time period were also included in the study. Linkage to HIV care was defined as attending for a CD4 count measurement within 6 months of HIV diagnosis. Linkage to ART care was defined as initiating ART within 6 months of HIV diagnosis in individuals with a CD4 count ≤200 cells/µl taken within 6 months of HIV diagnosis. FINDINGS: Only 62.6% of individuals attended for a CD4 count measurement within 6 months of testing HIV positive. Individuals testing through sexually transmitted infection services had the best (84.1%) and individuals testing on their own initiative (53.5%) the worst linkage to HIV care. One third of individuals with timely CD4 counts were eligible for ART and 66.7% of those were successfully linked to ART care. Linkage to ART care was highest among antenatal care clients. Among individuals not yet eligible for ART only 46.3% had a repeat CD4 count. Linkage to HIV care improved in patients tested in more recent calendar period. CONCLUSION: Linkage to HIV and ART care was low in this poor peri-urban community despite free services available within close proximity. More efforts are needed to link VCT scale-up to subsequent care

Women experience a better long-term immune recovery and a better survival on HAART in Lao People's Democratic Republic.

<p>Abstract</p> <p>Background</p> <p>In April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART.</p> <p>Methods</p> <p>We performed a retrospective database analysis on patients initiated on HAART between 2003 and 2009 (CD4<200cells/μL or WHO stage 4). We excluded from the analysis patients who were less than 16 years old and pregnant women. To explore the determinants of the CD4 reconstitution, a linear mixed model was adjusted. To identify typical trajectories of the CD4 cells, a latent trajectory analysis was carried out. Finally, a Cox proportional-hazards model was used to reveal predictors of mortality on HAART including appointment delay greater than 1 day.</p> <p>Results</p> <p>A total of 1365 patients entered the programme and 913 (66.9%) received an HAART with a median CD4 of 49 cells/μL [IQR 15–148]. High baseline CD4 cell count and female gender were associated with a higher CD4 level over time. In addition, this gender difference increased over time. Two typical latent CD4 trajectories were revealed showing that 31% of women against 22% of men followed a high CD4 trajectory. In the long-term, women were more likely to attend appointments without delay. Mortality reached 6.2% (95% CI 4.8-8.0%) at 4 months and 9.1% (95% CI 7.3-11.3%) at 1 year. Female gender (HR=0.17, 95% CI 0.07-0.44) and high CD4 trajectory (HR=0.19, 95% CI 0.08-0.47) were independently associated with a lower death rate.</p> <p>Conclusions</p> <p>Patients who initiated HAART were severely immunocompromised yielding to a high early mortality. In the long-term on HAART, women achieved a better CD4 cells reconstitution than men and were less likely to die. This study highlights important differences between men and women regarding response to HAART and medical care, and questions men’s compliance to treatment.</p

Comment utiliser l'expérience de financement basé sur les résultats (FBR) pour rendre l'achat des services de santé plus stratégique au Bénin ?

Le Bénin a expérimenté la mise en oeuvre du financement basé sur les résultats (FBR) dans le secteur de la santé selon deux approches. Suite à l'échec des tentatives d'harmonisation et de rationalisation de ces approches en vue de la pérennisation du FBR, le gouvernement du Bénin n'a pas pris les dispositions pour poursuivre sa mise en oeuvre. Dans la poursuite de la couverture santé universelle, le pays s'est engagé dans la voie de l'Assurance pour le renforcement du capital humain (ARCH) qui vise notamment à développer l'assurance maladie. Or, la promotion d'une couverture maladie nécessite entre autres de renforcer les mécanismes d'achat stratégique. Cet article synthétise les principaux éléments d'une note d'orientation élaborée par les experts en charge de l'appui scientifique au programme d'appui au secteur santé de l'Agence belge de développement.Il vise à proposer une évolution de l'approche de FBR mise en oeuvre au Bénin vers une approche d'achat stratégique des services et soins de santé, ceci en vue de garantir l'efficience, la qualité et l'équité de l'accès aux soins de santé. Il a pour vocation plus large de partager l'expérience du Bénin avec les pays et les partenaires qui souhaiteraient passer d'un programme de FBR appuyé par les donateurs à un mécanisme d'achat stratégique plus englobant et intégré dans le système local de santé. L'article se base sur une revue non systématique de la littérature et l'expérience des auteurs au Bénin et ailleurs. Tout d'abord, le concept d'achat stratégique est clarifié, et quelques leçons de l'expérience sont mises en avant, pouvant être utiles pour les pays qui souhaitent rendre l'achat des services de santé plus stratégique. Ensuite, les leçons apprises de l'expérience du FBR au Bénin sont présentées, qui touchent à la fois aux niveaux des processus stratégiques (importance d'adopter une vision systémique et de renforcer la redevabilité au niveau local), des processus techniques (importance de recourir aux structures pérennes en les renforçant, de limiter les coûts de transaction, de fournir des appuis complémentaires au renforcement du système local de santé), ainsi que des processus de suivi et des indicateurs de résultat (rationalisation des matrices d'indicateurs et des processus de vérification, accent sur des indicateurs ayant un effet de levier sur le système, équité). Quelques écueils sont également relevés (dont l'appropriation, la capitalisation des expériences et l'intégration des programmes de FBR dans les institutions existantes). Enfin, plusieurs pistes sont proposées dans le cadre de la transition du FBR vers l'achat stratégique. Il est suggéré, à court terme, d'adopter un aménagement transitoire du modèle de FBR, visant à le rationaliser. Après une période transitoire, l'accent devrait être mis sur quatre éléments de décision de l'achat stratégique à travers, d'une part, un appui au mécanisme d'assurance maladie pour ce qui concerne l'achat des prestations, ainsi qu'à l'Autorité de régulation du secteur de la santé pour le "stewardship" ; et d'autre part, la poursuite des appuis au système national d'information sanitaire ainsi qu'au renforcement des systèmes locaux de santé

Maternal health fee exemptions; policy brief

Sixty participants from 10 countries including four English-speaking (Ghana, Kenya, Nigeria, Sierra Leone) and six French-speaking (Benin, Burkina Faso, Mali, Morocco, Niger, Senegal) attended the workshop, which presented data from the ten countries as the basis for discussion and comparison of content, costs and financing of maternal health fee exemption policies. Countries also identified priority activities to implement to improve their maternal health fee exemption policies upon their return home. There is a lack of coordination both among different fee exemption policies in place (children under five, pregnant women, etc.) and other major initiatives designed to improve financial access

Determinants of survival in AIDS patients on antiretroviral therapy in a rural centre in the Far-North Province, Cameroon

The definitive version is available at www3.interscience.wiley.comObjective  To analyse the outcomes of antiretroviral therapy (ART) in routine conditions in a rural hospital in the Far-North province of Cameroon. Method  Retrospective cohort study of 1187 patients >15 years who started ART between July 2001 and December 2006. The survival time was estimated by Kaplan-Meier analysis and Cox proportional hazard models were fitted to explain survival. Results  Upon enrolment, 90.4% patients were in WHO stage III or IV and 56.1% had a BMI <18.5. Median CD4 count was 105 cells/mm³ (IQR 40-173). At the end of the study period, 338/1187 had died and 59/1187 were lost to follow-up. The survival probability was 77% at 1 year [95% CI: 75-80] and 47% at 5 years [95% CI: 40-55]. The median survival time was 58 months. CD4 count, haemoglobin, BMI, sex and clinical stage at enrolment were independent predictors of mortality. Conclusion  This study confirms the clinical benefit of ART programs in a remote and resource-constrained setting operating in routine conditions. The challenge ahead is to secure earlier access to ART and to maintain its longer-term benefit

How far is mixed methods research in the field of health policy and systems in Africa? A scoping review

International audienceBoth the academic and the policy community are calling for wider application of mixed methods research, suggesting that combined use of quantitative and qualitative methods is most suitable to assess and understand the complexities of health interventions. In spite of recent growth in mixed methods studies, limited efforts have been directed towards appraising and synthetizing to what extent and how mixed methods have been applied specifically to Health Policy and Systems Research (HPSR) in low- and middle-income countries (LMICs). We aimed at filling this gap in knowledge, by exploring the scope and quality of mixed methods research in the African context. We conducted a scoping review applying the framework developed by Arksey and O’Malley and modified by Levac et al. to identify and extract data from relevant studies published between 1950 and 2013. We limited our search to peer-reviewed HPSR publications in English, which combined at least one qualitative and one quantitative method and focused on Africa. Among the 105 studies that were retained for data extraction, over 60% were published after 2010. Nearly 50% of all studies addressed topics relevant to Health Systems, while Health Policy and Health Outcomes studies accounted respectively for 40% and 10% of all publications. The quality of the application of mixed methods varied greatly across studies, with a relatively small proportion of studies stating clearly defined research questions and differentiating quantitative and qualitative elements, including sample sizes and analytical approaches. The methodological weaknesses observed could be linked to the paucity of specific training opportunities available to people interested in applying mixed methods to HPSR in LMICs as well as to the limitations on word limit, scope and peer-review processes at the journals levels. Increasing training opportunities and enhancing journal flexibility may result in more and better quality mixed methods publications