Editorial: Opportunities for Surgical Research in the COVID-19 Era

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What are the key leadership competencies required by medical school deans in Uganda? A qualitative cross-sectional study

Background: Effective leadership is vital for organizational growth and sustainability. Globally, medical schools are faced with leadership challenges due to the pace of globalization, technological advances, reduced funding and changed funding cycles, increasing student enrolment, demands of accreditation, academic collaboration, innovations and research. This makes identification and selection for the right leadership competencies a priority.Objectives: To investigate the key leadership competencies required by deans of medical schools in Uganda.Method: A qualitative study using semi-structured interviews with the current deans and purposively selected former deans of medical schools in Uganda was conducted between March and June, 2020. We analysed the data using Grounded theory.Results: Thirteen (13) deans (9 of the 12 current deans and 4 former deans) participated in the study. We established ten (10) key roles of a dean of a medical school categorised as academic leadership, administrative leadership and professional leadership. Eleven (11) key competencies were identified as necessary for effective leadership of medical schools in Uganda, and categorized as personality-related competencies, organizational management competencies and medical/health expertise.Conclusions: A dean of a medical school in Uganda should possess a combination of personality, medical expertise, health professions training and organizational management competencies and have training in leadership, financial and resources management. Keywords: Competencies; effective leadership; medical schools; Dean

Hearing Lossin resource-limited settings: The Silent Overlooked Epidemic In Sub-Saharan African Children

Hearing Impairment is the most common disability reported worldwide and its consequences profoundly affect quality of life while impacting heavily on the economy. Despite this acknowledgement, priorities for healthcare in developing countries fall heavily on conditions such as malaria, tuberculosis and HIV, thus shifting attention away from other diseases and disabilities. The objective of this review was to outline key priority areas that should inform drafting policies for hearing impairment in developing countries. We undertook a literature search on PubMed, Google scholar, HINARI and Web of Science for publications discussing hearing loss in low- and middle-income countries. Search terms included “hearing loss”, “primary ear hearing care”, “hearing loss policies”, “hearing loss prevention”, “hearing loss causes” and “hearing loss detection”. We did not limit the publication period. However, we excluded all publications whose content did not contribute to the objective of our work. Our findings are discussed and recommendations given_________________________________________________________________________Keywords: Hearing loss, Sub - Saharian African, Childre

Building Research Capacity in Africa: Equity and Global Health Collaborations

Kathryn Chu and colleagues discuss the impact of high-income country investigators conducting research in low- and middle-income countries and explore lessons from the effective and equitable relationships that exist. Please see later in the article for the Editors' Summar

Surgery of COVID-19-infected patients in Africa: A scoping review

Objective: The aim of this scoping review was to highlight the nature and scope of research andpublications about surgery in COVID-19-infected patients in Africa in order to inform guidelinesapplicable in Africa. Methods: We considered peerreviewed and gray literature from PubMed, Google Scholar, and Word Health Organization COVID-19 online databases published from February 1, 2020, to February 28, 2021, about surgery for/in COVID-19-infected patients. The review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Results: Of 530 studies screened, only 11 (2.08%) were foundeligible, including 4 cohort studies, 3 cross-sectional studies, 2 letters to the editor, 1 case series, and 1 review. The key emphasis areas by the eligible studies were vaccination, testing prior to surgery, clinical guidelines to reduce complications related to COVID-19 among infected patients, and protection of the surgical team. Conclusion: There is a dearth of studies on surgery in COVID-19-infected patients in Africa. There is an urgent need for more reports and publications from the African experiences so as to inform contextualized guidelines for surgical care in low-resource settings during the COVID-19 pandemic

Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians

Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of nonphysician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health syste

Use of face masks to limit the spread of the COVID-19 among western Ugandans: Knowledge, attitude and practices

Background The world is grappling with an ever-changing COVID-19 pandemic using preventive measures such as personal hygiene, face masks, restrictions on travel and gatherings in communities, in addition to a race to find a vaccine. The purpose of this study was to evaluate the knowledge, attitudes and practices of the western Uganda community on the proper use of face masks to mitigate the spread of COVID-19. Methods A cross-sectional study using a structured questionnaire was carried out from 1st July to 10th July 2020 among western Ugandans of the consent age of 18 years and above. Data was analysed using Stata version 14.2. Results Among the respondents (n = 1114), the mean age was 30.7 (SD 11.1), 51% were males, 53.9% married and 43% had attained secondary education. Most participants (60.1%, n = 670) had satisfactory knowledge on the use of face masks and participants at a tertiary education level [AOR 2.6 (95% CI: 1.42–4.67; p = 0.002)] were likely to have satisfactory knowledge than participants who had not education. On attitude, most respondents (69.4%) were confident enough to correctly put on a face mask; 83.4% believed that a face mask can protect against COVID-19 and 75.9% of respondents had never shared their face mask. The majority of respondents (95.2%) agreed to wearing face masks in public places was important to protect themselves against COVID-19; 60.3% reported washing their hands before wearing and after removing the face mask. Unfortunately, 51.5% reported removing the face mask if they needed to talk to someone. Conclusion Despite the satisfactory knowledge, good attitude and practices, there is still much more to be done in terms of knowledge, attitude and practices among participants. Government, non-governmental organizations and civil society should improve sensitization of populations on how to behave with face masks while talking to avoid the spread of the COVID-19 among western Ugandans

Efficacy of extended focused assessment with sonography for trauma using a portable handheld device for detecting hemothorax in a low resource setting; a multicenter longitudinal study

Introduction: Chest trauma is one of the most important and commonest injuries that require timely diagnosis, accounting for 25-50% of trauma related deaths globally. Although CT scan is the gold standard for detection of haemothorax, it is only useful in stable patients, and remains unavailable in most hospitals in low income countries. Where available, it is very expensive. Sonography has been reported to have high accuracy and sensitivity in trauma diagnosis but is rarely used in trauma patients in low income settings in part due to lack of the sonography machines and lack of expertise among trauma care providers. Chest X-ray is the most available investigation for chest injuries in low income countries. However it is not often safe to wheel seriously injured, unstable trauma patients to X-ray rooms. This study aimed at determining the efficacy of extended focused assessment with sonography for trauma (eFAST) in detection of haemothorax using thoracostomy findings as surrogate gold standard in a low resource setting.Methods: This was an observational longitudinal study that enrolled 104 study participants with chest trauma. Informed consent was obtained from all participants. A questionnaire was administered and eFAST, chest X-ray and tube thoracotomy were done as indicated. Data were analysed using SPSS version 22. The sensitivity, specificity, predictive values, accuracy and area under the curve were determined using thoracostomy findings as the gold standard. Ethical approval for the study was obtained from the Research and Ethics Committee of Kampala International University Western Campus REC number KIU-2021-53.Results: eFAST was found to be superior to chest X-ray with sensitivity of 96.1% versus 45.1% respectively. The accuracy was also higher for eFAST (96.4% versus 49.1%) but the specificity was the same at 100.0%. The area under the curve was higher for eFAST (0.980, P = 0.001 versus 0.725, P = 0.136). Combining eFAST and X-ray increased both sensitivity and accuracy.Conclusion: This study revealed that eFAST was more sensitive at detecting haemothorax among chest trauma patients compared to chest X-ray. All patients presenting with chest trauma should have bedside eFAST for diagnosis of haemothorax.</p

An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries

CITATION: Rehfuess, Eva A., et al. 2016. An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries. Bulletin of the World Health Organization, 94:297–305, doi:10.2471/BLT.15.162966.The original publication is available at http://www.who.int/bulletin/en/ENGLISH SUMMARY : To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented.http://www.who.int/bulletin/volumes/94/4/15-162966-ab/en/Publisher's versio