Ebola : a call to strengthen the healthcare system and surveillance in West Africa

The recent Ebola disease epidemic in West Africa has remain a growing concern to many around the world. The disease, since it was reported in March, 2014 has claimed the lives of more than 5000 people in the West African sub-region. We undertook a rapid review to identify factors that impacted on how the three hardest hit West African countries: Guinea, Liberia and Sierra Leone have responded to the Ebola epidemic. We identified and reviewed relevant published and unpublished literatures on the Ebola epidemic since March, 2014. We sourced for relevant literature through electronic databases, as well as contacts with individuals. Our review revealed that the affected countries were barely prepared for the Ebola outbreak. Guinea, Liberia and Sierra Leone are faced with many healthcare systems challenges which impacted on the countries’ ability to control and manage the epidemic. The review identified specific healthcare system issues such as; inadequate human resource for health, lack of biosafety laboratories to fight any communicable disease outbreak including Ebola, inadequate health infrastructure and basic medical equipment as the main factors that contributed to poor management of the epidemic. There is the need for governments of West African countries to invest heavily in the strengthening of their healthcare systems to effectively manage epidemics such as Ebola

Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study

Objective To assess the prevalence and factors associated with modern contraceptive (CP) use among women of the reproductive age. Design Cross-sectional study. Setting We used data from the Multiple Indicator Cluster Surveys (MICSs) from 20 African countries collected between 2013 and 2018. Participants Data on 1 177 459 women aged 15–49 years old. Methods Multivariable logistic regression was used to identify factors associated with modern CP use, while controlling simultaneously for independent variables, and accounting for clustering, stratification and sample weights from the complex sampling design. We used random effects meta-analysis to pool adjusted estimates across the 20 countries. Results The overall prevalence of modern CP use was 26% and ranged from 6% in Guinea to 62% in Zimbabwe. Overall, injectable (32%) was the most preferred method of CP, followed by oral pill (27%) and implants (16%). Women were more likely to use a modern CP if they: had a primary (adjusted prevalence odds ratios (aPORs): 1.68, 95% CI: 1.47 to 1.91)) or secondary/higher education (aPOR: 2.16, 95% CI: 1.80 to 2.59) compared with women with no formal education; had no delivery in the last 2 years (aPOR: 3.89, 95% CI: 2.76 to 5.47) compared with women who delivered in the last 2 years; were aged 25–34 years (aPOR: 1.33, 95% CI: 1.20 to 1.47) compared with women aged 15–24 years; were of middle-income status (aPOR: 1.25, 95% CI: 1.11 to 1.39) or rich (aPOR: 1.53, 95% CI: 1.27 to 1.84) compared with poor women and had two or more antenatal care visits compared with women without a visit. Perceived domestic violence was not associated with modern CP use (aPOR: 0.98, 95% CI: 0.92 to 1.05). Conclusion Our findings are relevant in a global context, particularly in the African region, and improve our understanding on relevant factors essential to increasing modern CP use

Severe acute malnutrition in children aged under 5 years can be successfully managed in a non-emergency routine community healthcare setting in Ghana

This study investigated the performance of community-based management of severe acute malnutrition (CMAM) within routine healthcare services in Ghana. This was a retrospective cohort study of n = 488 children (6–59 months) who had received CMAM. Data for recovery, default, and mortality rates were obtained from enrolment cards in 56 outpatient centres in Upper East region, Ghana. Satisfactory rates of recovery of 71.8% were reported. Children who were enrolled with higher mid-upper arm circumference (MUAC) ≥11.5 cm had seven times greater chance of recovery compared with children who were enrolled with lower MUAC <11.5 cm, OR = 7.35, 95% CI [2.56, 21.15], p < .001. Children who were diagnosed without malaria at baseline were 30 times, OR = 30.39, 95% CI [10.02, 92.13], p < .001, more likely to recover compared with those with malaria (p < .001). The average weight gain was 4.7 g−1·kg−1·day−1, which was influenced by MUAC status at baseline, β = .78, 95% CI [0.46, 1.00], p < .001, presence of malaria, β = −1.25, 95% CI [−1.58, 0.92], p < .001, and length of stay, β = 0.13, 95% CI [0.08, 0.18], p < .001. The default rate (28.5%) was higher than international standards recommendations by Sphere. Mortality rate (1.6%) was lower than international standards. Our findings suggest that community-based management of SAM can achieve similar success when delivered in routine non-emergency settings. However, this success can be diluted by a high default rate, and the factors contributing to this need to be explored to improve programme effectiveness within communities

Flipped learning in the context of postgraduate public health higher education : a qualitative study involving students and their tutors

In higher education institutions, there is a growing popularity of the use of flipped learning (FL) pedagogy to enhance the learning experience of students. At the undergraduate level, there is increasing evidence to demonstrate the potential benefits of this teaching and learning approach. However, at the level of the postgraduate education, evidence is limited on potential impact of FL on students’ learning experience. We conducted qualitative in-depth interviews and focus groups involving postgraduate students and tutors to explore their perspectives of FL. Campus-based students pursuing the masters of public health (MPH) course, and their tutors at the School of Health and Related Research (ScHARR), University of Sheffield, UK were sampled to participate in the study. Tutors generally demonstrated good knowledge and understanding of the concept of FL and its application, although different tutors use different terms to describe FL. Motivations for the use of FL among tutors were identified as: decision informed by available evidence; curriculum design suited for FL; knowledge/expertise acquired through participating in an online FL short course; advise from colleagues and perception of how higher education students should be learning. Students’ views about FL suitability for their courses were generally positive, with only a few students showing a dislike of this teaching and learning method. Our study results show that tutors and postgraduate students in public health higher education place high value on FL pedagogy, and reported positive experiences of their encounter with the FL pedagogy. The results are encouraging and suggest that higher education institutions running postgraduate masters’ degree courses, particularly public health, could consider adopting and using FL approach to enhance the learning experiences of their students

Does maternal education impact infant and child care practices in African setting? The case of Northern Nigeria

Background: In many African settings, infant and child care practices are dictated by long-established social norms and cultural values, some of which may be disastrous to the health of the baby. To determine how maternal education is related with child health and rearing practices in Kano. Materials and Methods: Using a descriptive cross-sectional design, 386 randomly selected mothers of under-five children and their babies were examined. Data were analyzed using IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, NY, USA). Children's weight-for-height, height-for-age, and weight-for-age Z-scores were obtained. Infant and child care, feeding and weaning practices were assessed and scored based on a system adapted from past study. Results: The mean ± standard deviation of the mothers was 27.3 ± 5.2 years, 69.7% had at least secondary school education. The mothers had 4 ± 2 children, and 79.3% were ≥12 months old. More than half of the children (58.2%) had suffered one or more of the common childhood diseases within the previous month, 60.3% had a form of malnutrition and less than half (42.5%) were fully immunized for age. Varying infant and child care, feeding and weaning practices were observed. Overall, half (49.2%) of the mothers had good care practices, 42.2% had good feeding practices and 57.6% had good weaning practices. Interestingly, neither the mothers' care practices nor the feeding practices were statistically associated with their educational status. However, the proportion of the mothers with good weaning practices was higher among those with no secondary education (59.7%). Conclusion: The finding suggests that cultural beliefs are specific areas of focus in campaigns for improving infant and child care and rearing practices of mothers, and eventually for reducing the high infant and child morbidity and mortality in the Northern Nigeria

Relationships Between Recovery and Relapse, and Default and Repeated Episodes of Default in the Management of Acute Malnutrition in Children in Humanitarian Emergencies: A systematic review protocol

This protocol outlines plans for conducting a mixed-methods systematic review on acute malnutrition in humanitarian crises. The review will investigate the relationship between recovery/cure and relapse, and between relapse and default and/or return defaults/episodes of default in the management of acute malnutrition in children under five in humanitarian emergencies. The review will also explore the contexts in which acute malnutrition management programmes were implemented, in order to identify and describe how context influences relapse and default and/or return default/episodes. This review is funded through the Humanitarian Evidence Programme, a UK Aid-funded partnership between Oxfam and Feinstein International Center (FIC) at the Friedman School of Nutrition at Tufts University. The Humanitarian Evidence Programme aims to synthesize evidence in the humanitarian sector and communicate the findings to stakeholders, with the ultimate goal of improving humanitarian policy and practice

The effect of food type on the portion size effect in children aged 2-12 years: A systematic review and meta-analysis.

Visual cues such as plate size, amount of food served and packaging are known to influence the effects of portion size on food intake. Unit bias is a well characterised heuristic and helps to determine consumption norms. In an obesogenic environment where large portions are common place, the unit or segmentation bias may be overridden promoting overconsumption of both amorphous or unit foods. The aim of this review was to investigate the impact of offering unit or amorphous food on the portion size effect (PSE) in children aged 2–12 years. A systematic search for literature was conducted in Medline, PsycInfo and Web of Science in February 2018. A total of 1197 papers were retrieved following the searches. Twenty-one papers were included in the systematic review, of which 15 provided requisite statistical information for inclusion in a random effects meta-analysis. Increasing children's food portion size by 51–100% led to a significant increase in intake (SMD = 0.47, 95% CI: 0.39–0.55). There was no evidence to suggest that increases in consumption were related to food type (p = 0.33), child age (p = 0.47) or initial portion size served (p=0.14). Residual heterogeneity was not significant (p=0.24). The PSE was demonstrated in children aged 2–12 years when offered both unit and amorphous food items. The effect was not restricted by food type, child age or influenced by initial portion size served. Of the studies included in the meta-analysis between study heterogeneity was low suggesting minimal variation in treatment effects between studies, however, more research is required to understand the mechanisms of the PSE in preschool children. Future research should determine feasible methods to downsize portion sizes served to children

A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana

Background Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer. Conclusion The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers