End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

<p>Abstract</p> <p>Background</p> <p>End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence.</p> <p>Methods</p> <p>Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format.</p> <p>Results</p> <p>Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process.</p> <p>Conclusions</p> <p>The data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.</p

Dermatophytes and other pathogenic fungi from hospital staff apparel in Enugu, Nigeria

Background: It has been established that hospital staff apparel contributed to the spread of fungi infections in susceptible individuals (host). Objective: To isolate and identify fungi associated with hospital staff apparel. Methods: A total of 110 randomly selected hospital staff apparel from protective gown, face- shields and hand gloves were tested for the presence of fungi. Examined samples were collected using the swab culture method. Results: Of a total of 110 swab samples of hospital staff apparel, 56 (51 %) showed fungi contamination including 31 (66 %) of 47 samples from protective gowns, 18 of 40 (45 %) samples from Hand gloves and 7 of 23 (30 %) samples from faceshields. Eight (8) different genera of fungi were recovered. They included Penicillium sp, Aspergillus fumigatus, Fusarium sp, Alternaria alternata, Rhizopus stolonifer, Microsporum audouinii, Microsporum canis, Trichophyton rubrum, Trichophyton mentagrophytes and Candida albicans. Penicillium sp was the most predominant specie isolated. Conclusion: The isolation of clinically important fungi from the apparel suggests poor sanitary status and therefore the need for the existence of a health manual guide, which all staff should be obligated to follow, is necessary to improved infection control measures. Keywords: Contamination, fungi, hospital apparel. Sudanese Journal of Dermatology Vol. 4 (2) 2006: pp. 68-7

Isolation of Cryptococcus neoformans from bats (Molossus major) droppings in Awka, Nigeria.

The study determines the ecological significance of bats excrement in cryptococcosis in Awka, Nigeria. A total of 194 samples of bats droppings were collected from church, houses and public buildings. Each sample was suspended 1:10 in sterile normal saline solution and then cultured in Staib medium (Guizotia Abyssinica-creatine agar). Identification of Cryptococcus neoformans was performed based on the development of brown- coloured colonies and the presence of encapsulated yeast. Of 194 samples, 28 (14.4%) were positive for Cr.neoformans. The highest frequency was observed in dropping from houses (20.9%), followed by public buildings (12.3%) and churches (5%). No significant differences in isolation frequency were observed between fresh or dried excrement. All isolates obtained were Cr. neoformans var neoformans. The study further showed that bat excreta acquisition of cryptococcus is a potential source of infections to humans. Keywords: Cryptococcus neoformans var neoformans, bats dropping, Awka. Sudanese Journal of Dermatology Vol. 4 (2) 2006: pp. 81-8

Dermatophytes and other fungi associated with scalp-hair of nursery and primary schools

A total of 2,117 nursery and primary school children aged 1-13 years were surveyed for scalphair infection in Awka, Nigeria between January and March 2004. Specimens for mycological investigations were confirmed by microscopic examinations in 100 cases (4.7%) and the causative agents was isolated and cultured in 84 positive cases (3.9%). Zoophilic dermatophytes accounted for 42%, followed by geophilic (37%)a and anthropophilic (21%) dermatophytes. Microsporum gypseum and Trichophyton mentagrophytes were the main etiologic agents. Other nondermatophytic fungi species isolated were Alternaria alternata 14 (17%), Aspergillus fumigatus 10 (12%) Fusarium solani 7 (8%), Penicillium sp 3 (4%) and Candida albicans 3 (4%). Keywords: Mycosis, Hair-scalp, Dermatophytes, Dermatophytosis Sudanese Journal of Dermatology Vol. 5 (1) 2007: pp. 15-2