“Even if You Know Everything You Can Forget”: Health Worker Perceptions of Mobile Phone Text-Messaging to Improve Malaria Case-Management in Kenya

This paper presents the results of a qualitative study to investigate the perceptions and experiences of health workers involved in a a cluster-randomized controlled trial of a novel intervention to improve health worker malaria case-management in 107 government health facilities in Kenya. The intervention involved sending text-messages about paediatric outpatient malaria case-management accompanied by “motivating” quotes to health workers’ mobile phones. Ten malaria messages were developed reflecting recommendations from the Kenyan national guidelines. Two messages were delivered per day for 5 working days and the process was repeated for 26 weeks (May to October 2009). The accompanying quotes were unique to each message. The intervention was delivered to 119 health workers and there were significant improvements in correct artemether-lumefantrine (AL) management both immediately after the intervention (November 2009) and 6 months later (May 2010). In-depth interviews with 24 health workers were undertaken to investigate the possible drivers of this change. The results suggest high acceptance of all components of the intervention, with the active delivery of information in an on the job setting, the ready availability of new and stored text messages and the perception of being kept ‘up to date’ as important factors influencing practice. Applying the construct of stages of change we infer that in this intervention the SMS messages were operating primarily at the action and maintenance stages of behaviour change achieving their effect by creating an enabling environment and providing a prompt to action for the implementation of case management practices that had already been accepted as the clinical norm by the health workers. Future trials testing the effectiveness of SMS reminders in creating an enabling environment for the establishment of new norms in clinical practice as well as in providing a prompt to action for the implementation of the new case-management guidelines are justified

Endomyocardial Fibrosis: Still a Mystery after 60 Years

The pathologist Jack N. P. Davies identified endomyocardial fibrosis in Uganda in 1947. Since that time, reports of this restrictive cardiomyopathy have come from other parts of tropical Africa, South Asia, and South America. In Kampala, the disease accounts for 20% of heart disease patients referred for echocardiography. We conducted a systematic review of research on the epidemiology and etiology of endomyocardial fibrosis. We relied primarily on articles in the MEDLINE database with either “endomyocardial fibrosis” or “endomyocardial sclerosis” in the title. The volume of publications on endomyocardial fibrosis has declined since the 1980s. Despite several hypotheses regarding cause, no account of the etiology of this disease has yet fully explained its unique geographical distribution

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Simulation Monte Carlo des dépôts de doses en radiothérapie curiethérapie et déploiement sur grille de calcul

La méthode de calcul Monte Carlo est reconnue aujourd’hui comme l’algorithme pouvant modéliser au plus près les phénomènes physiques liés aux dépôts d’énergie dans un milieu. D’où l’intérêt d’utiliser cette méthode dans la planification de traitement du cancer par rayonnement, les systèmes de planification traitement (TPS) existant étant limités dans la précision des calculs pour certains cas bien spécifiques. Dans cette approche, nous nous intéressons à la validation du code de calcul Monte Carlo GATE pour les applications dosimétriques en physique médicale. Cependant, l’utilisation de la méthode Monte Carlo pour des géométries complexes ou des images de haute résolution nécessite de nombreuses heures de calculs. En effet, un résultat précis ne peut être obtenu qu’en générant beaucoup d’événements. Nous étudions donc les capacités de la grille de calcul de manière à réduire le temps de calcul en déployant nos simulations avec GATE sur un environnement de calcul distribué

Analyzing the contributions of transdisciplinary research to the global sustainability agenda in African cities

It is almost 6 years since the UN's Sustainable Development Goals (SDGs) were adopted, and countries have less than 10 years to achieve the set targets. Unlike most of the world, sub-Saharan African countries have reported only minimal progress, one that the COVID-19 pandemic has unfortunately disrupted. Transdisciplinary research (TDR) has been conceptualized as important for achieving sustainability goals such as the SDGs. In this paper we (i) analyze the contributions of the five TDR projects toward the achievements of the SDGs at the city level in Africa, and (ii) explore the interactions between the assessed SDGs across the five projects. The projects' contributions towards the achievements of the SDGs were examined in three thematic areas: (i) contexts, (ii) processes and (iii) products. The five projects were funded under the Leading Integrated Research for Agenda 2030 in Africa (LIRA) programme. The projects were being implemented in nine cities across five African countries Accra (Ghana), Kumasi (Ghana), Korhogo (Ivory Coast), Abuja Metro (Nigeria), Mbour (Senegal), Cape Town (South Africa), Nelson Mandela Bay Metro (South Africa), Grahamstown (South Africa) and Kampala (Uganda) and data were collected on each of the five projects in these cities. The contextual contributions include co-analysis and reflection on policy and institutional silos and social innovations amenable to contextual complexity. A shift in how actors perceived and conceptualized sustainability challenges and the role of the projects as transformative social agents constituted the two main process contributions. Tool development, virtual models and maps, and handbook are the product contributions by the projects. Our analysis of the SDG interactions indicated the need for cross-sectoral collaborations to ensures resource use efficiency, knowledge and experience sharing, and seamless flow of information and data to accelerate the SDG implementation