Feeding the homeless through collaboration: A proposal for consideration

The homeless are faced with many challenges of adverse nutritional deficiencies that predispose them to several illnesses commonly associated with the lack of adequate nutrition and the frequent utilizations of health care resources. Provision of nutritious food for the homeless can help decrease the prevalence of these identifiable markers and can be accomplished by u collaborative effort. The purpose of this project is to describe a collaboration between Regions Hospital and the Dorothy Day Center to provide supplemental nutrition for the homeless. Leininger\u27s culture care diversity and universality theory along with culture care accommodation/negotiation are used as a theoretical framework to support this work. The steps involved in the creation of this project as well as recommendations for continual success and expansion are discussed

"Fear of stigma is stronger than fear of death": a workplace initiative to reduce sickness and death due to HIV/AIDS among health staff in Malawi

Mexico AIDS Conference 200

Does Antiretroviral Treatment Reduce Case Fatality Among HIV-Positive Patients with Tuberculosis in Malawi?

SETTING: Thyolo district, Malawi. OBJECTIVES: To report on 1) case fatality among human immunodeficiency virus (HIV) positive tuberculosis (TB) patients while on anti-tuberculosis treatment and 2) whether antiretroviral treatment (ART) initiated during the continuation phase of TB treatment reduces case fatality. DESIGN: Retrospective cohort analysis. METHODS: Comparative analysis of treatment outcomes for TB patients registered between January and December 2004. RESULTS: Of 983 newly registered TB patients receiving diagnostic HIV testing, 658 (67%) were HIV-positive. A total of 132 (20%) patients died during the 8-month course of anti-tuberculosis treatment, of whom 82 (62%) died within the first 2 months of treatment when ART was not provided (cumulative incidence 3.0, 95%CI 2.5-3.6 per 100 person-years). A total of 576 TB patients started the continuation phase of anti-tuberculosis treatment, 180 (31%) of whom were started on ART. The case-fatality rate per 100 person-years was not significantly different for patients on ART (1.0, 95%CI 0.6-1.7) and those without ART (1.2, 95%CI 0.9-1.7, adjusted hazard ratio 0.86, 95%CI 0.4-1.6, P = 0.6) CONCLUSIONS: ART provided in the continuation phase of TB treatment does not have a significant impact on reducing case fatality. Reasons for this and possible measures to reduce high case fatality in the initial phase of TB treatment are discussed

Achieving universal access to antiretroviral therapy in a rural district in Malawi: how was it done?

Mexico AIDS Conference 200

Lower Limb Amputation at the 34 Military Hospital in Freetown, Sierra Leone: Causes and Indications.

The global prevalence of diabetes mellitus is increasing substantially. This overall increment leads to the growth in the number of individuals with diabetic complications including lower limb amputation. In low-income countries like Sierra Leone, lack of access to adequate health care, poverty and social stigma attached to “amputation” all prevent people from seeking early medical treatment for diabetic foot.The purpose of this study was to document the causes and indications of lower limb amputations and to make appropriate recommendations to the health sector of Sierra Leone.This retrospective study was conducted at 34 Military Hospital, one of the major referral hospitals in Freetown, between January 2011 and December 2014. A team of medical staff was trained to extract data. The operating theatre and ward case records were searched for information (age, gender, cause and indication for amputation) of all the patients who underwent amputation during this period. The findings were statistically documented in tables.Twenty-seven patients (24 males and 3 females) were involved in the study. The age distribution was 15-65 years (Mean 43). Majority (77.7%) of the patients presented with gangrenous and infected diabetic feet, 18.5 % was due to Road Traffic Accident and 3.8% due to complication of HIV infection. The commonest level was transtibial amputation 85% and 67% was right sided. Hospital stay was 20-50 days (average 35). There was no postoperative mortality.As most amputations were done for diabetic feet, there is need for diabetes sensitization and prevention campaigns for the general public and improvement of diabetic care for individual patients including proper glycemic control and risk factors prevention. Increased funding is required by the health sector of Sierra Leone to implement these measures. Prevention of road traffic accidents by training/educating the drivers should also be considered by Sierra Leone Road Transport Authority.

DOES ANTIRETROVIRAL TREATMENT REDUCE CASE-FATALITY AMONG HIV-POSITIVE PATIENTS WITH TUBERCULOSIS IN MALAWI?

Cape Town TB Conferenc

Mapping academic literature on governing inclusive green growth in Africa: geographical biases and topical gaps

A strong indigenous capacity for credible, salient and legitimate knowledge production is crucial to support African countries in developing their economies and societies inclusively and sustainably. In this article, we aim to quantify the current and historic capacity for African knowledge production to support the green economy in Africa, and identify important topical gaps. With a focus on topics relating to Governing Inclusive Green Growth in Africa (GIGGA), our research mapped how much Africa-focused research is being produced, from where and which African countries have higher or lower supply; and the topical focus of the research, mapping it against the African GIGGA policy discourses visible in government strategies. To do this we undertook a systematic review using a two-stage process, mapping the literature for GIGGA. This resulted in 960 verified citations. Content analysis of core metadata and article abstracts enabled mapping of the research focus. The analysis revealed a significant role for South Africa as both the pre-eminent producer of GIGGA literature as well as the geographic focus of GIGGA research, with Nigeria, Ethiopia and Kenya representing emerging loci of credible, African-relevant knowledge production. Topically, there was a strong emphasis on development, policy and environment while topics important for growth that is inclusive in character were infrequent or absent. Overall the results reinforced the view that investment is needed in research on inclusive green growth, linked to capacity building for knowledge production systems in Africa. Furthermore, from a policy perspective, policy makers and academics need to actively explore best to collaborate to ensure that academic research informs government policy

Cabergoline for suppression of puerperal lactation in a prevention of mother-to-child HIV-transmission programme in rural Malawi.

This study shows that cabergoline (single oral-dose) is an acceptable, safe and effective drug for suppressing puerperal lactation. It could be of operational benefit not only for artificial feeding, but also for weaning in those that breast-feed within preventive mother-to-child HIV transmission programmes in resource-limited settings

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study.

Despite having safe and efficacious vaccines against COVID-19, vaccine hesitancy is widespread. Although a trusted source of information, vaccine hesitancy has been reported among healthcare professionals, yet few studies have explored this phenomenon in sub-Saharan Africa. We conducted a cross-sectional survey of healthcare professionals in Sierra Leone from January to March 2022. Measures included sociodemographic/health-related information and COVID-19-related concerns. From the responses, we constructed a hesitancy (VAX) score, with higher scores implying negative attitudes or unwillingness to vaccinate. Multivariate linear regression was used to access factors associated with vaccine hesitancy. Overall, 592 participants submitted responses (67.2% female, mean age 29 years, 5.6% physicians/pharmacists, 44.3% medical students, 29.2% nurses, 20.9% nursing students). The mean VAX score was 43.27 ± 8.77, with 60.1% of respondents classified as vaccine hesitant (>50th percentile) and 13.8% as highly hesitant (>75th percentile). Worries about unforeseen future effects (76.3%), a preference for natural immunity (59.5%), and profiteering/mistrust of health authorities (53.1%) were the most common concerns. Being a medical student (β = 0.105, p = 0.011) and previously refusing a recommended vaccine (β = 0.177, p < 0.001) were predictors of COVID-19 vaccine hesitancy. Our findings call for addressing vaccine hesitancy among healthcare professionals as an essential component of strategies aimed at increasing COVID-19 vaccine uptake in this setting