Proposed guidelines for the management of nodding syndrome

Nodding Syndrome is a poorly understood neurologic disorder of unknown aetiology that affects children and adolescents in Africa. Recent studies have suggested that the head nods are due to atonic seizures and Nodding Syndrome may be classified as probably symptomatic generalised epilepsy. As part of the Ugandan Ministry of Health clinical managementresponse, a multidisciplinary team developed a manual to guide the  training of health workers with knowledge and skills to manage the  patients. In the absence of a known cause, it was decided to offer  symptomatic care. The objective is to relieve symptoms, offer primary and secondary prevention for disability and rehabilitation to improve function. Initial management focuses on the most urgent needs of the patient and the immediate family until ‘stability’ is achieved. The most importantneeds were considered as seizure control, management of behavioural and psychiatric difficulties, nursing care, nutritional and subsequently, physical and cognitive rehabilitation. This paper summarises the processes by which the proposed guidelines were developed and provides an outline of the specific treatments currently being provided for the patients

Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey.

Background Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services. Methods Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple dimensions of health care access and screening focusing on the affordability, availability, accessibility, accommodation and acceptability components. Results About 1 in 4 (25.3%, n = 65) of the women who attended a health care facility in the past year got screened for cervical cancer. Screened women had a significantly higher number of health care providers available compared with unscreened women (mean 125 vs.12, p-value Conclusions Our findings suggest that cost issues (affordability component) and other patient level factors (captured in the acceptability, accessibility and accommodation components) were less important predictors of screening compared with availability of physicians in this population. Meeting cervical cancer screening and HPV vaccination goals will require significant investments in the health care workforce, improving health care worker density in poor and rural areas, and improved training of the existing workforce

Omics-based molecular techniques in oral pathology centred cancer: Prospect and challenges in Africa

: The completion of the human genome project and the accomplished milestones in the human proteome project; as well as the progress made so far in computational bioinformatics and “big data” processing have contributed immensely to individualized/personalized medicine in the developed world.At the dawn of precision medicine, various omics-based therapies and bioengineering can now be applied accurately for the diagnosis, prognosis, treatment, and risk stratifcation of cancer in a manner that was hitherto not thought possible. The widespread introduction of genomics and other omics-based approaches into the postgraduate training curriculum of diverse medical and dental specialties, including pathology has improved the profciency of practitioners in the use of novel molecular signatures in patient management. In addition, intricate details about disease disparity among diferent human populations are beginning to emerge. This would facilitate the use of tailor-made novel theranostic methods based on emerging molecular evidences

Stereotypes on Nodding syndrome: responses of health workers in the affected region of northern Uganda

Background: Nodding Syndrome is a debilitating disorder of yet unknown etiology that has affected children and adolescents aged 3 – 18 years in parts of sub Saharan African countries including Uganda, South Sudan, Tanzania and Liberia. Objective: To identify stereotypes and negative attitudes held by primary care health workers about nodding syndrome. Method: Of one hundred health workers invited by the Uganda Ministry of Health for training on nodding syndrome from the three most affected districts of Pader, Lamwo and Kitgum forty were interviewed using a predesigned tool. Content and thematic analysis was applied. Results: There were 22 females. The median age was 33 years (range 23-54 years). The participants included Psychiatric Clinical Officers, Medical Clinical Officers, Laboratory Technicians, Midwives, Registered and Enrolled Nurses. Overall, four broad categories of negative stereotypes were identified; Nodding syndrome is 1) an incurable disease, 2) is associated with evil spirits and curses, 3) is disabling, making the patient a burden to society and 4) is a fatal illness. Conclusion: Primary health care workers who lead the care of patients with nodding syndrome have several negative stereotypes that may potentially impact negatively on the quality of care they provide

Yield-reliability analysis and operating rules for run-of-river abstractions for typical rural water supply: Siloam Village case study

The study focused on yield-reliability analysis and operating rules for optimum scheduling of run-of-river (ROR) abstractions for typical rural water supply schemes using Siloam Village, Limpopo Province, South Africa, as a case study. Efficient operation of water supply systems requires operating rules as decision support tools. System operation methods have hardly been developed or applied to water supply to rural communities that depend on ROR abstractions. Simulated runoff was used to derive unregulated river yield at different levels of assurance of supply (LAS) for Nzhelele River at Siloam Village using 1-day flow duration curves. Yield-reliability analysis results were used to derive operating rules. The results show that Nzhelele River can meet domestic and low-flow requirements at 50–80% (1:2-1:5) LAS. The low-flow and domestic water requirements can be partially met at 90% (1:10) LAS. The generic operating rules for ROR abstractions were consequently derived from the procedure used in developing operating rules for Nzhelele River. This enables generation of operating rules for ROR abstractions in any typical rural water supply system

Evaluation of the current status of prosthetic rehabilitationservices for major limb loss: a descriptive study in UgandanReferral Hospitals

Background: Low-income-and-middle-income countries (LMICs) have a largeburden of major limb loss. No recent study has reported on Uganda’s state ofpublic sector prosthetics services. This study aimed to document the landscape ofmajor limb loss, and the structure of available prosthetics services in Uganda.Methods: This study involved a retrospective review of medical records atMulago National Referral Hospital, Fort Portal Regional Referral Hospital, andMbale Regional Referral Hospital, and a cross-sectional survey of personnelinvolved in the fabrication and fitting of prosthetic devices across orthopaedicworkshops in the country.Results: Upper limb amputations accounted for 14.2%, and lower limbaccounted for 81.2%. Gangrene (30.3%) was the leading cause of amputation,followed by road traffic accidents and diabetes mellitus. Orthopaedic workshopsoffered decentralised services, and most materials used were imported. Essentialequipment was largely lacking. Orthopaedic technologists had diverse experienceand skillsets, but many other factors limited their service provision.Conclusion: The Ugandan public healthcare system lacks adequate prostheticservices both in terms of personnel and supporting resources, includingequipment, materials, and components. The provision of prosthetics rehabilitationservices is limited, especially in rural regions. Decentralising services couldimprove patients’ access to prosthetic services