Dose Variation To Critical Points In Low Dose Rate Intracavitary Brachytherapy Of Cervical Cancer As Justification For Incident Learning

Background: Low Dose Rate (LDR) brachytherapy necessitates a more extended treatment duration. This technique maintains the patient on the treatment machine for a longer length of time, which may cause changes in the applicators' position due to vaginal packing soaking and patient movement for incident learning justification. Objective: The purpose of this study is to evaluate pre- and post-dosage variation to points 'A' and 'B,' as well as vital organs (i.e. bladder and rectum), for low dose rate (LDR) brachytherapy at Komfo Anokye Teaching Hospital and justify the need for incident learning system. Method: Forty (40) patients with invasive cervical cancer were treated with LDR brachytherapy equipment (A Curietron Cesium Manuel (AMRA)-France, CA 98.22) to point 'A' at doses ranging from 30 to 35 Gy. Adult patients selected for the study ranged from 25 to 60 years simulated. For each patient, orthogonal images of anterior-posterior (AP) and (LAT) were taken by positioning the patient on the Varian Acuity Simulator Couch at 00 and 900, respectively, and two sets of orthogonal images (before and after treatment), in each case, were considered. The treatment was then planned using the AP and LAT images obtained based on the four arrangements used, namely 1-2-5, 1-3-5, 1-4-5, and 1-5. The treatment planning system used for the study was the Prowess Panther system 4.6. Results: The dosage disparity at point 'A' was determined to be 1.16 per cent, which is highly commendable compared to previous research that established dose variations of 2%, 35%, 8%, and 20%. In this study, the dosage variation at point B was 0.75 per cent. The bladder and rectum had average alterations of 2.32 per cent and 0.30 per cent, respectively. Conclusion: The difference observed between prescribed, and deposited dosage was 2.11 per cent for quality assurance and incident learning reasons. Unrealistic expectations, reliance on reminders and quick remedies, and faults in the systemic view of failure were discovered and addressed as managerial issues. It is critical not to underestimate these difficulties because they are frequently significantly more severe than the technical issues being addressed. Incident issues were not recorded per patients under review, but near misses and non-conformance were observed. The geometric variances between the Intracavitary Brachytherapy Treatment (ICBT) applicators and the essential organs change during the treatment process, resulting in dosage changes. Does variance is within the required standard limits; it can be stated that Komfo Anokye Teaching Hospital's practice satisfies the international standard and is an intrusion into the Directorate Incident Learning System

Does the data tell the true story? : A modelling assessment of early COVID-19 pandemic suppression and mitigation strategies in Ghana

Acknowledgments Most of this work was undertaken from April to July 2020 during the early phase of the COVID-19 pandemic in Ghana. We are grateful to have risen to the call to national duty to support Ghana’s national response to the pandemic during this particularly challenging time. We are grateful to two anonymous peer-reviewers who provided useful feedback which improved the paperPeer reviewedPublisher PD

Bacterial etiology of sexually transmitted infections at a STI clinic in Ghana; use of multiplex real time PCR

Background: Most sexually transmitted infection (STI) management efforts focus on the syndromic approach to diagnose and treat patients. However, most women with STIs have been shown to be entirely asymptomatic, or if symptoms exist, are often missed when either clinical or conventional bacteriologic diagnostic tools are employed.Methods: We assessed the performance of a multiplex real time PCR assay to describe other potential pathogens that could be missed by conventional bacteriological techniques in 200 women attending a routine STI clinic in Kumasi, Ghana.Results: Although a total 78.00% of the women were asymptomatic, 77.1% of them tested positive for at least one bacterial STI pathogen. Mycoplasma genitalium was the most commonly detectable pathogen present in 67.5% of all women. Of those testing positive, 25.0% had single infections, while 38.0% and 19.5% had double and triple infections respectively. Altogether, 86.54% and 90.91% of the symptomatic and asymptomatic women respectively tested positive for at least one pathogen (p<0.05). There were no significant associations (p<0.05) between the clinical manifestations of the symptomatic women and the pathogens detected in their samples.Conclusions: Our study confirmed the importance of complementing the syndromic approach to STI management with pathogen detection and most importantly recognise that STIs in women are asymptomatic and regular empirical testing even for both symptomatic and asymptomatic patients is critical for complete clinical treatment.Funding: EOD (Ellis Owusu-Dabo Research working group, KCCR)Keywords: Etiology, Syndromic, Sexually Transmitted Infections, Multiplex real time PC

Embed capacity development within all global health research

Summary box • All countries, including low- and middle-income countries, need robust health research capacity • The research capacity gap between global North and South is closing too slowly, and governments, funders, and academic institutions are not investing sufficiently to bridge this chasm • With two examples from collaborative research projects in sub-Saharan Africa, we illustrate how capacity development can be an integrated part of a joint research effort supported by all involved institutions • We advocate that research capacity development be valued as highly as evidence generation and be embedded in all global health researc

Embed capacity development within all global health research.

Summary box • All countries, including low- and middle-income countries, need robust health research capacity • The research capacity gap between global North and South is closing too slowly, and governments, funders, and academic institutions are not investing sufficiently to bridge this chasm • With two examples from collaborative research projects in sub-Saharan Africa, we illustrate how capacity development can be an integrated part of a joint research effort supported by all involved institutions • We advocate that research capacity development be valued as highly as evidence generation and be embedded in all global health researc

Availability and price of malaria rapid diagnostic tests in the public and private health sectors in 2011: results from 10 nationally representative cross-sectional retail surveys.

OBJECTIVES: To describe the state of the public and private malaria diagnostics market shortly after WHO updated its guidelines for testing all suspected malaria cases prior to treatment. METHODS: Ten nationally representative cross-sectional cluster surveys were conducted in 2011 among public and private health facilities, community health workers and retail outlets (pharmacies and drug shops) in nine countries (Tanzania mainland and Zanzibar surveyed separately). Eligible outlets had antimalarials in stock on the day of interview or had stocked antimalarials in the past 3 months. RESULTS: Three thousand four hundred and thirty-nine rapid diagnostic test (RDT) products from 39 manufacturers were audited among 12,197 outlets interviewed. Availability was typically highest in public health facilities, although availability in these facilities varied greatly across countries, from 15% in Nigeria to >90% in Madagascar and Cambodia. Private for-profit sector availability was 46% in Cambodia, 20% in Zambia, but low in other countries. Median retail prices for RDTs in the private for-profit sector ranged from $0.00 in Madagascar to$3.13 in Zambia. The reported number of RDTs used in the 7 days before the survey in public health facilities ranged from 3 (Benin) to 50 (Zambia). CONCLUSIONS: Eighteen months after WHO updated its case management guidelines, RDT availability remained poor in the private sector in sub-Saharan Africa. Given the ongoing importance of the private sector as a source of fever treatment, the goal of universal diagnosis will not be achievable under current circumstances. These results constitute national baselines against which progress in scaling-up diagnostic tests can be assessed

Stakeholder perspectives from 15 countries in Africa on barriers in snakebite envenoming research and the potential role of research hubs

Snakebite envenoming is a debilitating neglected tropical disease disproportionately affecting the rural poor in low and middle-income countries in the tropics and sub-tropics. Critical questions and gaps in public health and policy need to be addressed if major progress is to be made towards reducing the negative impact of snakebite, particularly in the World Health Organisation (WHO) Africa region. We engaged key stakeholders to identify barriers to evidence-based snakebite decision making and to explore how development of research and policy hubs could help to overcome these barriers. We conducted an electronic survey among 73 stakeholders from ministries of health, health facilities, academia and non-governmental organizations from 15 countries in the WHO Africa region. The primary barriers to snakebite research and subsequent policy translation were limited funds, lack of relevant data, and lack of interest from policy makers. Adequate funding commitment, strong political will, building expert networks and a demand for scientific evidence were all considered potential factors that could facilitate snakebite research. Participants rated availability of antivenoms, research skills training and disease surveillance as key research priorities. All participants indicated interest in the development of research and policy hubs and 78% indicated their organization would be willing to actively participate. In conclusion, our survey affirms that relevant stakeholders in the field of snakebite perceive research and policy hubs as a promising development, which could help overcome the barriers to pursuing the WHO goals and targets for reducing the burden of snakebite

Towards a comprehensive research and development plan to support the control, elimination and eradication of neglected tropical diseases.

To maximise the likelihood of success, global health programmes need repeated, honest appraisal of their own weaknesses, with research undertaken to address any identified gaps. There is still much to be learned to optimise work against neglected tropical diseases. To facilitate that learning, a comprehensive research and development plan is required. Here, we discuss how such a plan might be developed

‘The medicine is not for sale’: Practices of traditional healers in snakebite envenoming in Ghana

Background Snakebite envenoming is a medical emergency which is common in many tropical lower-and middle-income countries. Traditional healers are frequently consulted as primary care-givers for snakebite victims in distress. Traditional healers therefore present a valuable source of information about how snakebite is perceived and handled at the community level, an understanding of which is critical to improve and extend snakebite-related healthcare. Method The study was approached from the interpretive paradigm with phenomenology as a meth-odology. Semi-structured interviews were conducted with 19 traditional healers who treat snakebite patients in two rural settings in Ghana. From the Ashanti and Upper West regions respectively, 11 and 8 healers were purposively sampled. Interview data was coded, col-lated and analysed thematically using ATLAS.ti 8 software. Demographic statistics were analysed using IBM SPSS Statistics version 26. Findings Snakebite was reportedly a frequent occurrence, perceived as dangerous and often deadly by healers. Healers felt optimistic in establishing a diagnosis of snakebite using a multitude of methods, ranging from herbal applications to spiritual consultations. They were equally confident about their therapies; encompassing the administration of plant and animal-based concoctions and manipulations of bite wounds. Traditional healers were consulted for both physical and spiritual manifestations of snakebite or after insufficient pain control and lack of antivenom at hospitals; referrals by healers to hospitals were primarily done to receive anti-venom and care for wound complications. Most healers welcomed opportunities to engage more productively with hospitals and clinical staff. Conclusions The fact that traditional healers did sometimes refer victims to hospitals indicates that improvement of antivenom stocks, pain management and wound care can potentially improve health seeking at hospitals. Our results emphasize the need to explore future ave-nues for communication and collaboration with traditional healers to improve health seeking behaviour and the delivery of much-needed healthcare to snakebite victims