A systematic review of interventions to promote human papillomavirus (HPV) vaccination in Africa

Objective We conducted a systematic review to assess the scope and effectiveness of interventions to improve human papilloma virus (HPV) vaccination in Africa from 2006 to 2021. Study design Systematic review. Methods Four databases (Medline, Embase, CINAHL and PsycINFO) were searched for articles published between 2006 and 2021. Articles were screened and included based on eligibility criteria using DistillerSR (Version 2.35). Data were extracted and reported using a narrative synthesis. A quality assessment was also conducted for each study using validated quality appraisal tools. Results Out of 7603 articles identified by a systematic search, 18 articles met the inclusion criteria. Included studies comprised impact evaluation and cross-sectional studies published between 2012 and 2021 and conducted in eight African countries namely: Nigeria, Cameroon, South Africa, Kenya, Tanzania, Zambia, Mali, and Malawi. Study quality ranged from high to low quality. Interventions comprised fifteen educational and three multicomponent interventions. Out of thirteen impact evaluation studies (all educational interventions), twelve studies were effective in increasing HPV vaccine uptake and/or improving participants' knowledge, attitudes, and perceptions about the vaccine. Across five cross-sectional studies (two educational and three multicomponent interventions), HPV vaccine uptake rates ranged from 34% to 93.3%, with a consensus on safety and effectiveness in 67.9%–90.3% of participants post-intervention. Conclusion Educational and multicomponent interventions have been implemented to improve HPV vaccination in Africa. While educational interventions have proven effective at improving HPV vaccine uptake, a more diverse range of interventions with robust impact evaluation study designs are needed to strengthen the available evidence and improve vaccine uptake

CONCENTRATION AND POTENTIAL HEALTH RISK ASSOCIATED WITH DIETARY INTAKE OF SMOKED FISH FROM LAGOS LAGOON

This study assessed the concentration and potential health risk associated with dietary exposure to polycyclic aromatic hydrocarbons (PAHs) in smoked fish products from four fishing communities along Lagos Lagoon, Nigeria. Sixty smoked fish samples obtained from two fish species (Chrysichthys nigrodigitatus and Elops lacerta) which were processed individually with three firewood (Cola nitida, Funtumia elastica and Alchornea cordifolia) were collected from fish processors between October and December, 2018. Samples were subjected to polycyclic aromatic hydrocarbons (PAHs) analysis using gas chromatography-mass spectrometry (GC-MS) and human health risk model analysis. The PAH congeners varied in smoked fish while Pyrene was the most dominant congener in all the fish samples, accounting for more than 70% of the total PAHs. The highest total PAHs levels (2431.85 mg kg-1) was observed in E. lacerta smoked with C. nitida. The Dietary Daily Intake (DDI) values for total and carcinogenic PAHs were higher in E. lacerta smoked with C. nitida and C. nigrodigitatus smoked with A. cordifolia, respectively. Carcinogenic Toxic Equivalent (TEQ) values were lower than the estimated Screening Value (SV) of 12.83 indicating low risk of developing cancer through consumption of assessed smoked fish products. Excess Cancer Risk estimated exceeded the permissible limit (1.0x10−6) set by USEPA. Positive correlations (P<0.01) existed between TEQ and total PAHs, noncarcinogenic PAHs, PAH4, and DDI. This study provides insights into the variation in PAHs level and appropriateness of different fuelwood for smoking similar or dissimilar fish species

Improving Access to Antimicrobial Prescribing Guidelines in 4 African Countries: Development and Pilot Implementation of an App and Cross-Sectional Assessment of Attitudes and Behaviour Survey of Healthcare Workers and Patients

martphone apps have proven to be an effective and acceptable resource for accessing information on antimicrobial prescribing. The purpose of the study is to highlight the development and implementation of a smartphone/mobile app (app) for antimicrobial prescribing guidelines (the Commonwealth Partnerships for Antimicrobial Stewardship—CwPAMS App) in Ghana, Tanzania, Uganda and Zambia and to evaluate patients’ and healthcare providers’ perspectives on the use of the App in one of the participating institutions. Two structured cross-sectional questionnaires containing Likert scale, multiple-choice, and open-ended questions were issued to patients and healthcare workers six months after the introduction of the app at one of the hospital sites. Metrics of the use of the app for a one-year period were also obtained. Download and use of the app peaked between September and November 2019 with pharmacists accounting for the profession that the most frequently accessed the app. More than half of the responding patients had a positive attitude to the use of the app by health professionals. Results also revealed that more than 80% of health care workers who had used the CwPAMS App were comfortable using a smartphone/mobile device on a ward round, considered the app very useful, and found it to improve their awareness of antimicrobial stewardship, including documentation of the indication and duration for antimicrobials on the drug chart. It also encouraged pharmacists and nurses to challenge inappropriate antimicrobial prescribing. Overall, our findings suggest that its use as a guide to antimicrobial prescribing sparked positive responses from patients and health professionals. Further studies will be useful in identifying the long-term consequences of the use of the CwPAMS App and scope to implement in other settings, in order to guide future innovations and wider us

Assessment of health budgetary allocation and expenditure toward achieving universal health coverage in Nigeria

Context: The implementation of the Universal Health Coverage (UHC) promotes access to quality health care delivery through cost-effective initiatives to ensure good health and wellbeing without discrimination. This study examines government finance, budgetary allocation, and expenditure as key health development indicators towards achieving the UHC in Nigeria. Evidence Acquisition: Data analyzed in the study were gotten from journal articles, reports and other secondary sources. Searches were conducted in PubMed, Google Scholar, and WHO Library Database with pre-determined search terms. Further publications were identified through snowballing of citations and references. We reviewed only papers written in English with no date restrictions placed on searches. Results: Within the period of analysis, the annual national health budgetary allocation in Nigeria has been below the 2001 Abuja declaration of allocating 15% of the national budget to health. Our analysis also revealed that if the Abuja declaration was implemented, additional allocations of NGN 4.99 trillion should have been injected into the health sector between 2014 and 2020. In addition, Nigeria also lags behind relative to some other low-and middle-income countries in terms of government expenditure to the health sector in achieving the UHC. Conclusions: The inadequate budgetary allocation in Nigeria to healthcare has significantly influenced recurrent and capital health expenditure. It is worthy to note that the insufficient allocation will continue to significantly affect capital expenditure which is a large determinant of the development of any health system. With the current state of healthcare budget allocation in Nigeria, efforts need to be intensified to ensure the achievement of UHC. In the face of achieving UHC, reviewing the system of healthcare financing and ensuring prudent allocation of resources while shifting the focus from out-of-pocket payments for health is essential. We also recommend increase in political commitment towards improving the health of the populace so as to ensure health systems goals of efficiency, equity, quality of care, sustainability, financial risk protection for all citizens are achievable

Influence of stenosis severity on hemodynamics flow at low Reynolds numbers: A computational fluid dynamic study

The restriction of blood flow due to narrowing of arteries that supply blood to different parts of the body leads to high blood pressure and cholesterol in humans. In this study, blood flow in a 3D model of arterial stenosis was examined using computational fluid dynamics (CFD) technique. The geometry of the stenosis was modeled using ANSYS software, and a structured tetrahedral mesh was generated for accurate representation. The CFD analysis was performed using the ANSYS (FLUENT) 19.2 commercial code to investigate three stenosis levels of 75%, 50%, and 25% over the Reynolds number range of 500-2000 with blood as the working fluid. The blood flowed steadily upstream of the stenosis as incompressible, homogeneous, and Newtonian, while the artery is considered to be inflexible. The Reynolds-averaged Navier-Stokes equations and the low Reynolds number SST k-ω turbulence model were employed to simulate the blood flow. The governing equations are solved, and the pressure-velocity coupling is handled using the SIMPLEC algorithm.  The steady state velocity and pressure generated at the inlet and outlet of the artery enabled the hemodynamic properties and flow reversal through arteries with a progressive amount of atherosclerosis to be determined. The results are presented in terms of velocity distribution, streamlines, and turbulence intensity contours. The results showed that at the throat (Z = 0) of the 75% stenosis, the relative magnitude of the velocity is greater than or equal to four times the average velocity. Reversal of flow is visible at   for Re = 500 and  for Re = 750 and Re = 2000. Furthermore, the effects of 25% stenosis on the flow pattern are relatively blunt and weak at . The throat of the stenosis, or a site therein, exhibits the highest value of centerline velocity, while turbulence intensity becomes severe at the post-stenotic site and they both increase with increasing stenosis level. The study provides valuable insights into the velocity distribution, flow reversal phenomenon, and turbulence intensity in arterial stenosis. The findings highlight the significant impact of stenosis levels and Reynolds numbers on the hemodynamic behavior, offering important considerations for understanding and managing arterial health issues

Tackling antimicrobial resistance : developing and implementing antimicrobial stewardship interventions in four African commonwealth countries through a health partnership model

Peer reviewe

COVID-19 and antimicrobial resistance: a review

As the world continues to respond to the coronavirus pandemic (COVID-19), there is a larger hidden threat of antimicrobial resistance (AMR) lurking behind. AMR remains worrisome in that the pathogens causing resistant infections to thrive in hospitals and medical facilities, putting all patients at risk, irrespective of the severity of their medical conditions, further compounding the management of COVID-19. This study aims to provide overview of early findings on COVID-19 and AMR as well as to provide recommendations and lesson learned toward improving antimicrobial stewardship. We conducted a rapid narrative review of published articles by searching PubMed and Google Scholar on COVID-19 and Antimicrobial Resistance with predetermined keywords. Secondary bacterial infections play crucial roles in mortality and morbidity associated with COVID-19. Research has shown that a minority of COVID-19 patients need antibiotics to treat secondary bacterial infections. Current evidence reiterates the need not to give antibiotic therapy or prophylaxis to patients with mild COVID-19 or to patients with suspected or confirmed moderate COVID-19 illness unless it is indicated. The pandemic has also brought to the fore the deficiencies in health systems around the world. This comes with a lot of lessons, one of which is that despite the advances in medicine; we remain incredibly vulnerable to infections with limited or no standard therapies. This is worth thinking in the context of AMR, as the resistant pathogens are evolving and leading us to the era of untreatable infections. There is a necessity for continuous research into understanding and controlling infectious agents, as well as the development of newer functional antimicrobials and the need to strengthen the antimicrobial stewardship programs

How West African countries prioritize health.

BACKGROUND: The goal of Universal Health Coverage (UHC) is to ensure that everyone is able to obtain the health services they need without suffering financial hardship. UHC remains a mirage if government health expenditure is not improved. Health priority refers to general government health expenditure as a percentage of general government expenditure. It indicates the priority of the government to spend on healthcare from its domestic public resources. Our study aimed to assess health priorities in the Economic Community of West African States (ECOWAS) using the health priority index from the WHO's Global Health Expenditure Database. METHOD: We extracted and analysed data on health priority in the WHO's Global Health Expenditure Database across the 15 members of the ECOWAS (Benin, Burkina Faso, Cabo Verde, Cote d'Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo) from 2010 to 2018 to assess how these countries prioritize health. The data are presented using descriptive statistics. RESULTS: Our findings revealed that no West African country beats the cutoff of a minimum of 15% health priority index. Ghana (8.43%), Carbo Verde (8.29%), and Burkina Faso (7.60%) were the top three countries with the highest average health priority index, while Guinea (3.05%), Liberia (3.46%), and Guinea-Bissau (3.56%) had the lowest average health priority in the West African region within the period of our analysis (2010 to 2018). CONCLUSION: Our study reiterates the need for West African governments and other relevant stakeholders to prioritize health in their political agenda towards achieving UHC