Population health trends analysis and burden of disease profile observed in Sierra Leone from 1990 to 2017

Additional file 1: Supplementary Figure 1. CMNN and NCD combined mortality rates. Supplementary Figure 2. Top 10 Diseases for CMNN and NCD combined. Supplementary Table 1. CMNNs risk factors. Supplementary Table 2. NCD Risk factors.BACKGROUND : Sierra Leone, in West Africa, is one of the poorest developing countries in the world. Sierra Leone has experienced several recent challenges namely, a civil war from 1991 to 2002, a massive Ebola outbreak from 2014 to 2016, followed by floods and landslides in 2017. In this study, we quantified the burden of disease in Sierra Leone over a 27-year period, from 1990 to 2017. METHODOLOGY : In this descriptive study, we analysed secondary data from the Institute of Health Metrics and Evaluation, Global Burden of Disease (GBD) study. We quantified patterns of burden of disease, injuries, and risk factors in Sierra Leone. We report GBD data and metrics including mortality rates, years of life lost and risk factors for all ages and both sexes from 1990 to 2017. RESULTS : From 1990 to 2017, trends of mortality rates for all ages and sexes have declined in Sierra Leone although mortality rates remain some of the highest when compared to other developing countries. The burden of communicable, maternal, neonatal, and nutritional (CMNN) diseases are greater than the burden of non-communicable diseases (NCDs) due to the prevalence of endemic diseases in Sierra Leone. The most important CMNNs associated with premature mortality included respiratory infections, neglected tropical diseases, malaria, and HIV-Aids. Life expectancy has increased from 37 to 52 years. CONCLUSION : Sierra Leone’s health status is gradually improving following the civil war and Ebola outbreak. Sierra Leone has a double burden of disease with CMNNs leading and NCDs progressively increasing. Despite these challenges, Sierra Leone has promising initiatives and programs pursuing the Universal Health Coverage 2030 Sustainable Developmental Goals Agenda. There is need for accountability of available resources, clear rules and expected roles for non-governmental organisations to ensure a level playing field for all actors to rebuild the health system.http://www.biomedcentral.com/bmcpublichealtham2023School of Health Systems and Public Health (SHSPH)Statistic

Preventing antenatal stillbirths : an innovative approach for primary health care

BACKGROUND : In South Africa (SA), approximately 16 000 stillbirths occur annually. Most are classified as unexplained and occur in district hospitals. Many of these deaths may be caused by undetected foetal growth restriction. Continuous wave Doppler ultrasound of the umbilical artery (CWDU-UmA) is a simple method for assessing placental function. This screening method may detect the foetus at risk of dying and growth-restricted foetuses, allowing for appropriate management. METHODS : A cohort study was conducted across South Africa. Pregnant women attending primary health care clinics at 28–34 weeks gestation were screened using CWDU-UmA. Women not screened at those antenatal clinics served as control group 1. Control group 2 consisted of the subset of control group 1 with women detected with antenatal complications excluded. Women with foetuses identified with an abnormal CWDU-UmA test were referred and managed according to a standardised protocol. A comparison between the study and control groups was performed. RESULTS : The study group consisted of 6536 pregnancies, and there were 66 stillbirths (stillbirth rate [SBR]: 10.1/1000 births). In control group 1, there were 193 stillbirths in 10 832 women (SBR: 17.8/1000 births), and in control group 2, 152 stillbirths in 9811 women (SBR: 15.5/1000 births) (risk ratio: 0.57, 95% confidence intervals: 0.29–0.85 and 0.65, 0.36–0.94, respectively). CONCLUSION : Screening a low-risk pregnant population identified the low-risk mother with a high-risk foetus, and acting on the information as described was associated with a significant reduction (35% – 43%) in stillbirths. This demonstrates a step-change reduction in stillbirths and warrants screening in SA.This study was part of the PhD thesis of T.M.H. "The effect of introducing Basic Antenatal Care Plus and Umbiflow on antenatal care and perinatal mortality" available at https://repository.up.ac.za/handle/2263/85609.The South African Medical Research Council (SAMRC) and the Council for Scientific and Industrial Research (CSIR).https://www.safpj.co.zaam2023Obstetrics and GynaecologyStatistic

The COVID-19 pandemic and disruptions in a district quality improvement initiative : experiences from the CLEVER Maternity Care programme

BACKGROUND : Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs. METHODS : This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers. RESULTS : Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers’ response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging. CONCLUSION : Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication.This study was part of the CLEVER Maternity Care project funded by Merck Sharp & Dohme Corporation (MSD) under the auspices of its Merck for Mothers programme.https://www.safpj.co.zaam2023Family MedicineStatistic

The demography and disease burden of the homeless shelter population of Tshwane during COVID-19

BACKGROUND : Homeless people are a vulnerable population susceptible to physical and mental health care problems. There are, however, limited studies and information regarding the health of the homeless population. AIM : To describe and understand the burden of disease among the homeless population in Tshwane District, Gauteng, South Africa. SETTING : Data were collected from 15 different homeless shelters created during the South African 2020 coronavirus disease 2019 (COVID-19) lockdown in the Tshwane District, from April to July 2020. METHODS : A cross-sectional survey was conducted among the homeless people in the shelters to provide information of self-reported conditions that the homeless populations at the shelters had during the lockdown period. The participants were also screened for medical conditions like, human immunodeficiency virus (HIV), hypertension (HPT) and diabetes mellites (DM). RESULTS : Results showed a total of 2066 homeless population out of which 1391 took part in the survey. Most of the participants consisted of African males 93.83%, with substance use prevalence in 52.77%. The study showed that the population was very reluctant to share information and had less chronic conditions than originally thought. CONCLUSION : Efforts should be made to improve education and research around the homeless population, by government and non-government facilities by building relationships with homeless shelters in their areas. CONTRIBUTION : This study provides awareness of the homeless population's health and challenges, with the intention to attempt a better understanding of the population that may present themselves to primary healthcare (PHC) facilities and encourage future investigation into how to improve care.http://www.phcfm.orgam2023Family Medicin

Identifying the high-risk fetus in the low-risk mother using fetal Doppler screening

Identifying the high-risk fetus in the low-risk pregnant mother (LRM) is a neglected area of research. Fetal growth restriction (FGR) is a major cause of stillbirths, especially in low- and middle-income countries (LMICs). FGR is very poorly detected particularly in healthy pregnant women classified as low risk. Umbiflow is an inexpensive continuous-wave Doppler ultrasound (CWDU) apparatus that is suitable for use by low-level health care providers for screening low-risk pregnant populations. It can easily detect umbilical artery blood flow in the cord, which correlates well with placental function, and poor placental function correlates well with FGR. Use of CWDU to screen an LMIC population of more than 7,000 LRMs has demonstrated a high prevalence of abnormal umbilical artery flow of 13%, and absent end-diastolic flow, which is associated with end-stage placental disease, was found in 1.2%. This is 10 times higher than previously reported in high-income countries. Screening with CWDU together with a standard protocol managing those pregnancies with abnormal placental blood flow resulted in a 43% reduction in stillbirths (risk ratio: 0.57; 95% confidence interval= 0.29, 0.85) in this LRM population. Further, follow-up of infants who had abnormal umbilical artery blood flow showed that these infants had significantly less fat-free mass at ages 6 weeks, 10 weeks, 14 weeks, and 6 months, than those with normal umbilical artery blood flow (P<.015), confirming that CWDU was able to detect true FGR. Thus, screening with CWDU can detect the fetus at risk of stillbirth, and infants likely to have suboptimal growth and development postnatally. Screening with CWDU in LRMs opens the door to a step change in preventing stillbirths in LMICs.https://www.ghspjournal.orgam2023Paediatrics and Child Healt

Epidemiology, clinical characteristics, and risk factors for running-related injuries among South African trail runners

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.File S1: Online consent form and baseline questionnaire, File S2: Online follow-up questionnaire on the Qualtrics platform, File S3: The frequency of tissue and pathology types of RRIs among trail runners.https://www.mdpi.com/journal/ijerpham2022PhysiotherapySports MedicineStatistic

One in five trail running race entrants sustained an injury in the 12 months training period before the 2021 Mac Mac ultra race

DATA AVAILABILITY: Data are available upon reasonable request.BACKGROUND : Trail running is characterised by large elevation gains/losses and varying uneven running surfaces. Limited literature is available to help guide injury prevention strategies among trail runners. The purpose of this study was to determine the epidemiology, clinical characteristics, and related risk factors for running-related injuries (RRIs) amid trail runners who entered the 2021 Mac Mac Ultra races. METHODS : DESIGN : Descriptive cross-sectional study. SETTING : 2021 Mac Mac Ultra Race. PARTICIPANTS : Consent for data analysis was given by 251 of 330 (76%) race entrants. MAIN OUTCOME MEASURES : Point prevalence (%), frequency (n, %), retrospective annual incidence (RRIs/100 athlete-years), characteristics (pathology type, tissue type, body area, anatomical region), and associated injury risk factors (training and demographic variables) of RRIs. RESULTS : In the sample, the retrospective annual incidence was 19.92/100 athlete-years. The point prevalence was 4%. Injuries mostly appeared in the lower limb (95%), with the lower leg (26%), thigh (22%), ankle and foot (13%) described as the highest injured body areas. Of tissue type injuries, muscle/tendon comprised 60%. Muscle injury (36%), tendinopathy (24%), and joint sprain (9%) were the most reported pathology types. No related injury risk factors were discovered in this study. CONCLUSIONS : One in five trail runners reported one or more RRI during the 12 months before a competitive event. RRIs commonly involved the low.https://www.mdpi.com/journal/applsciPhysiotherapySports MedicineStatistic

MRI findings in chronic exertional compartment syndrome of the forearm : using signal intensity ratio as a diagnostic tool

BACKGROUND : Chronic exertional compartment syndrome (CECS) of the forearm is a rare but important cause of morbidity amongst athletes involved in strenuous upper limb activities. The diagnosis remains challenging due to the absence of objective, reproducible diagnostic studies. OBJECTIVES : To assess and quantify signal intensity (SI) changes of involved muscles in patients with CECS of the forearm compared to healthy control subjects competing in similar sporting disciplines. Also, to objectively measure MRI SIs within muscle compartments when using a pre- and post-exercise regime and calculating a signal intensity ratio (SIR) between post- and pre-exercise studies. METHOD : The study retrospectively examined MRI scans of patients treated for CECS of the forearm and compared these to the MRI scans of asymptomatic high-level rowers. A specific, reproducible pre- and post-exercise MRI scanning protocol was utilised in both patient and control subjects between 2011 and 2020. Signal intensities were evaluated pre- and post- exercise in involved muscle groups and ratios were calculated. RESULTS : A total of 86 SIs were measured (43 pre- and 43 post-exercise) in nine study participants (five patients and four controls). After post:pre-exercise comparisons, a statistically significant difference was found between control and patient groups (p = 0.0010). The extensor carpi radialis, flexor digitorum profundus and flexor digitorum superficialis muscles were most commonly involved. CONCLUSION : This study confirms that significant SI changes are apparent in patients with CECS of the forearm when making use of a standardised pre- and post-exercise MRI protocol. Furthermore, SIR may be used to accurately diagnose CECS of the forearmThe Capital Radiology Practice and the Pretoria MR Trust.http://www.sajr.org.zahj2022RadiologySports MedicineStatistic

The epidemiology of injury and illness at the Vitality Netball World Cup 2019 : an observational study

BACKGROUND : Netball is a physical game with sudden direction changes, decelerations, jumping and landing, stop/start maneuvers and restrictive footwork rules exposing players to injury. Close contact play and shared facilities during tournaments, increase illness risk. OBJECTIVE : To describe incidence, period prevalence, types and severity of injuries and illnesses during the 10-day Vitality Netball World Cup 2019 (NWC). METHODS : All players from 16 teams consented (n = 192). Medical staff recorded injuries (840 exposure hours), illnesses (1440 player-days) and time-loss. Main outcome measures included incidence (I) calculated as injury/1000 player-hours and illness/1000 player-days, period prevalence (PP) and severity (time-loss) of all match injuries and illnesses. RESULTS : 39 players sustained 46 match injuries (I = 54.76; PP = 20.31%). Lower limb injuries (I = 29.76), specifically the ankle (I = 13.10) were most common with lateral ankle ligament sprains the highest (I = 17.39). Contact injuries (I = 40.48) significantly exceeded non-contact injuries (I = 14.29; p = 0.0124). Center players sustained most injuries (n = 12; 26%; I = 14.29), followed by goalkeepers (n = 10; 22%; I = 11.90) and goal defenders (n = 8; 17%; I = 9.52). Injuries occurred in almost 50% of matches, and 67% did not result in time-loss. Time-loss injuries (n = 14; 33%) were most frequent in the lower limb (n = 10; 71%) specifically involved lateral ankle ligaments (n = 4; 29%), attributable to contact (n = 11; 79%) and mostly implicated center players and goal defenders (n = 4 each; 29% each). 11 players contracted 11 illnesses (I = 7.64; PP = 5.72%) with respiratory tract illness contributing 36%. Most illnesses did not result in time-loss (91%). CONCLUSION : This is the first study reporting injury and illness during an NWC. Contact was the main mechanism of injury, and 2/3 of injuries did not result in time-loss. The ankle is most commonly injured and center players sustain most injuries. Non-respiratory system disease was most frequent, but upper respiratory tract infection remains the most common diagnosis. Targeted surveillance studies using similar methodology are required to develop injury and illness preventative strategies in elite netball.https://tandfonline.com/toc/ipsm202022-06-07hj2021Sports MedicineStatistic

South African Healthcare Professionals’ Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed-Methods Study

Climate change, biodiversity loss and large-scale environmental degradation are widely recognized as the biggest health threats of the 21st century, with the African continent already amongst the most severely affected and vulnerable to their further progression. The healthcare system’s contribution to climate change and environmental degradation requires healthcare professionals to address environmental issues urgently. However, the foundation for context-relevant interventions across research, practice, and education is not readily available. Therefore, we conducted a convergent mixed-methods study to investigate South African healthcare professionals’ knowledge, attitudes, practices, and barriers to environmental sustainability. Healthcare professionals participated in a cross-sectional questionnaire (n = 100) and in-depth semi-structured focus group discussions (n = 18). Data were analyzed using descriptive statistics and thematic analysis, respectively, and integrated to provide holistic findings. Our results confirm overwhelmingly positive attitudes and a high degree of interest in education, implementation, and taking on more corresponding responsibility, but a lack of substantial knowledge of the subject matter, and only tentative implementation of practices. Identified barriers include a lack of knowledge, resources, and policies. Further research, education, and policy development on overcoming these barriers is required. This will facilitate harnessing the extant enthusiasm and advance environmental sustainability in South Africa’s healthcare practice