Utility of Prostate Specific Antigen (PSA) in the Indigenous African Man

Objectives: To examine the great possibility that the indigenous black African man with prostate diseases requires a different diagnostic approach and strategies beyond the standard PSA reference levels generated in non-African study subjects.Design: A hospital based cross-sectional descriptive study.Setting: The Urology Outpatient Clinic and Surgical Ward of Moi Teaching and Referral Hospital, Eldoret, Kenya between 1st April 2012 to 31st March 2013.Subjects: Two hundred and nineteen patients aged 50 years and above with prostate diseases.Main Outcome Measures: The main outcome measure was the PSA levels in patients diagnosed with Acute Prostatitis, Benign Prostate Hyperplasia (BPH) and Prostate Cancer in MTRH. The secondary outcome measures were the correlates associated with elevated PSA.Results: Patients ranged in age from 50 to 96 years with a mean ±  standard deviation of 65.4 ± 10.2 years. Clinical diagnosis of Acute  Prostatitis, BPH and Prostate Cancer was made in 1.8, 63.9 and 34.3% of the study subjects respectively. Sixty-two patients (28.3%) had PSA in the laboratory reference range of 0-4ng/ml considered normal with an average of 1.8 ng/ml. The overall mean was 31.2 ng/ml and those with elevatedPSA levels had a mean of 42.3 ng/ml. There was a positive correlate between prostate enlargement, urine retention, dysuria and family history of prostate disease and elevated PSA (all with p<0.001).Conclusions: The indigenous black African man has high levels of PSA even in benign prostate diseases. This together with histological findings of malignancy in some clinically diagnosed BPH with normal range PSA levels make the use of PSA in this group a bigger challenge. Studies should be conducted to not only elucidate the best use of PSA in the indigenous black African man but also his place in the new biomarkers to supplement or replace PSA in diagnosis and care

Early Outcome of the Types of Urethroplasty in a Tertiary Centre in Northern Tanzania

BackgroundUrethral strictures remain a major problem in the developing countries unlike in the developed world. It is prudent to establish the success rates of various methods of urethroplasty in our regional setting.Patients And MethodsPatients who underwent various types of urethroplasty at the Institute of Urology at Kilimanjaro Christian Medical Centre (KCMC) from February 2009 to April 2011 were involved in this hospital based descriptive, prospective, cohort study. The available options for urethroplasty were anastomotic, staged and substitution urethroplasties and were chosen on the basis of institutional protocol on site, number and length of stricture and recommended form of urethroplasty. Urethral and suprapubic catheters were left insitu and on the third post operative day, urethral catheter was spigoted. Patients stayed in the ward for seven days then discharged home for two weeks when they would come for urethral catheter removal on the 21st postoperative day.ResultsOne hundred and five patients underwent urethroplasty. The age ranged from 4 years to 83 years with a mean ±Standard Deviation of 45.8± 18.5 years. Eighty-four point eight percent of the strictures were in the anteriorurethra. The overall success rate for urethroplasty was 88.4%. The specific success rates were 87.3% for anastomotic, 92% for staged and 93% for substitution urethroplasty.ConclusionThe urethroplasty success rate in KCMC compares favorably with other tertiary centers in the world. Substitution urethroplasty has the best outcome for stricture surgery

Clinical Characteristics of African Men with Prostate Diseases in a Tertiary Centre in Western Kenya

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Hospitalizations and Costs Incurred at the Facility Level After Scale-Up of Malaria Control: Pre-Post Comparisons From Two Hospitals in Zambia

There is little evidence on the impact of malaria control on the health system, particularly at the facility level. Using retrospective, longitudinal facility-level and patient record data from two hospitals in Zambia, we report a pre-post comparison of hospital admissions and outpatient visits for malaria and estimated costs incurred for malaria admissions before and after malaria control scale-up. The results show a substantial reduction in inpatient admissions and outpatient visits for malaria at both hospitals after the scale-up, and malaria cases accounted for a smaller proportion of total hospital visits over time. Hospital spending on malaria admissions also decreased. In one hospital, malaria accounted for 11% of total hospital spending before large-scale malaria control compared with \u3c 1% after malaria control. The findings demonstrate that facility-level resources are freed up as malaria is controlled, potentially making these resources available for other diseases and conditions

The Dependency on Central Government Funding of Decentralised Health systems: Experiences of the Challenges and Coping Strategies in the Kongwa District, Tanzania.

Decentralised health systems in Tanzania depend largely on funding from the central government to run health services. Experience has shown that central funding in a decentralised system is not an appropriate approach to ensure the effective and efficient performance of local authorities due to several limitations. One of the limitations is that funds from the central government are not disbursed on a timely basis, which in turn, leads to the serious problem of shortage of financial resources for Council Health Management Teams (CHMT). This paper examines how dependency on central government funding in Tanzania affects health activities in Kongwa district council and the strategies used by the CHMT cope with the situation. The study adopted a qualitative approach and data were collected using semi-structured interviews and focus group discussions. One district in the central region of Tanzania was strategically selected. Ten key informants involved in the management of health service delivery at the district level were interviewed and one focus group discussion was held, which consisted of members of the council health management team. The data generated were analysed for themes and patterns. The results showed that late disbursement of funds interrupts the implementation of health activities in the district health system. This situation delays the implementation of some activities, while a few activities may not be implemented at all. However, based on their prior knowledge of the anticipated delays in financial disbursements, the council health management team has adopted three main strategies to cope with this situation. These include obtaining supplies and other services on credit, borrowing money from other projects in the council, and using money generated from cost sharing. Local government authorities (LGAs) face delays in the disbursement of funds from the central government. This has necessitated introduction of informal coping strategies to deal with the situation. National-level policy and decision makers should minimise the bureaucracy involved in allocating funds to the district health systems to reduce delays

Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study

Background: PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. Methods: We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. Results: We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. Conclusion: The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04066881

Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study

Background PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. Methods We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. Results We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. Conclusion The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. Trial registration https://clinicaltrials.gov/ct2/show/NCT0406688

Spatiotemporal climate and vegetation greenness changes and their nexus for Dhidhessa River Basin, Ethiopia

Background Understanding spatiotemporal climate and vegetation changes and their nexus is key for designing climate change adaptation strategies at a local scale. However, such a study is lacking in many basins of Ethiopia. The objectives of this study were (i) to analyze temperature, rainfall and vegetation greenness trends and (ii) determine the spatial relationship of climate variables and vegetation greenness, characterized using Normalized Difference in Vegetation Index (NDVI), for the Dhidhessa River Basin (DRB). Quality checked high spatial resolution satellite datasets were used for the study. Mann–Kendall test and Sen’s slope method were used for the trend analysis. The spatial relationship between climate change and NDVI was analyzed using geographically weighted regression (GWR) technique. Results According to the study, past and future climate trend analysis generally showed wetting and warming for the DRB where the degree of trends varies for the different time and spatial scales. A seasonal shift in rainfall was also observed for the basin. These findings informed that there will be a negative impact on rain-fed agriculture and water availability in the basin. Besides, NDVI trends analysis generally showed greening for most climatic zones for the annual and main rainy season timescales. However, no NDVI trends were observed in all timescales for cool sub-humid, tepid humid and warm humid climatic zones. The increasing NDVI trends could be attributed to agroforestry practices but do not necessarily indicate improved forest coverage for the basin. The change in NDVI was positively correlated to rainfall (r2 = 0.62) and negatively correlated to the minimum (r2 = 0.58) and maximum (r2 = 0.45) temperature. The study revealed a strong interaction between the climate variables and vegetation greenness for the basin that further influences the biophysical processes of the land surface like the hydrologic responses of a basin. Conclusion The study concluded that the trend in climate and vegetation greenness varies spatiotemporally for the DRB. Besides, the climate change and its strong relationship with vegetation greenness observed in this study will further affect the biophysical and environmental processes in the study area; mostly negatively on agricultural and water resource sectors. Thus, this study provides helpful information to device climate change adaptation strategies at a local scale