Working Paper 118 - Assessment of the Trade Finance Market in Africa Post-Crisis

The financial crisis, which began to hit the trade finance markets in 2008, caused a sharp slow-down in trade in 2008 and 2009. The tightening of global credit reduced capital inflows and curtailed the availability of trade finance. This sudden shortage of trade finance negatively impacted African economies. In response, the African Development Bank (AfDB) established, on March 2009, a multiphase USD 1 billion Trade Finance Initiative (TFI). As part of the Trade Finance Initiative, AfDB commissioned a trade finance survey conducted three times between 2009 and 2010. The financial institutions contacted during these market surveys are listed at the end of this document. During this research, banks in Senegal, Burkina Faso, Ghana, Nigeria, Egypt, Morocco, Kenya, South Africa, Tanzania and Rwanda were contacted. In addition, financial institutions active in the international and regional trade finance markets based in the USA, UK, France, Germany and the Netherlands were contacted. Finally, development finance institutions active in supporting trade both within Africa and without were interviewed. Generally trade operations officers, international department management, treasury officers or senior commercial bankers were contacted. Participants were asked to: • Describe their trade finance related activities • Describe the state of the market for trade finance products • Describe how availability of facilities has changed •Describe how terms and conditions of facilities have changed •Discuss overall economic activity in their markets • Discuss potential roles for AfDB to play to facilitate access to trade finance The overall conclusions of these surveys are: • African trade grew rapidly during the pre-crisis period, spurred by growing south-south trade and the emergence of Asia as a major purchaser of African raw materials and primary products. Anecdotally, it appears that trade finance was increasingly available during this period. • The crisis has had a negative impact on African trade due to falling demand for African primary product exports. Trade finance availability was sharply constrained during the initial crisis period. • It is difficult to discern real trends in African trade finance as markets remain highly volatile. Liquidity and risk appetite vary widely across markets and counterparties. Across all markets, trade finance tenors have shortened. • There is an overall decrease in demand for trade products due to decreased economic activity but a higher proportion of the current transactions are using trade instruments. • International commercial banks that historically provided confirmation lines for trade instruments remain risk averse and seek to maintain/increase returns. • Low income countries and the smaller Regional Member Countries are hit hardest by the lack of availability of trade finance due to higher perceived risk, even for low risk transactions. • Basel II related capital allocation rules will have a negative impact on the cost and availability of trade finance across the continent. • Multilateral Development Banks in other regions play a variety of roles to support trade finance availability, from which AfDB could learn some lessons. • The African Development Bank can have a significant impact on trade finance availability and, consequently, RMC economic performance over the short/medium term.

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Advantages And Limitations Of Using Speech Recognition Systems In Health Care And Practical Means To Solve Their Application

&nbsp;Background and Aim:&nbsp;The applicability of any technology to enter a certain field is determined by defining the advantages and disadvantages of the system in that field. The aim of this study is to show the advantages and limitations of using speech recognition systems in health care and providing practical solutions to improve the acceptability of the system in that field.&nbsp;Materials and Methods:&nbsp;This is a descriptive research with a review method that employs library resources and online databases such as Proquest, Pubmed, Science Direct, Ovid and Scientific Information databases using key words like speech recognition software, health care, benefits, barriers, and solutions.&nbsp;Results: Speech recognition system has many advantages like increased accuracy of medical documentation, and reduced documentation time. It is a tool for data entry into electronic health records. However, there are several limitations in applying the system in Iran, such as the lack of definition of database system and the high cost of hardware and software. &nbsp;Conclusion: Considering the study results in relation to the benefits and limitations of systems in healthcare area, solutions such as production of a national integrated database for the exchange of health information, improving database to increase the accuracy of word recognition, and training the users of the system can reduce the limitations of the system to some extent. Also, in the country’s movement towards the implementation of electronic health records and the users’ need to enter data into the computer, the software is a good alternative to keyboard and mouse input.&nbsp

Using proportional assist ventilation to wean a prolonged mechanically ventilated patient with chronic obstructive pulmonary disease

Long-term mechanical ventilation (MV) increases heath care cost. Difficult-to-wean patients represent a challenge to health care providers and patient′s family. Patient with chronic obstructive pulmonary diseases (COPDs) are usually difficult to wean off mechanical ventilators for many pathophysiological reasons. Modes of ventilation used in MV weaning have produced variable results. The main shortcoming of currently available modes of weaning is inability to meet patient′s changing ventilator demand. Proportional assist ventilation (PAV) is a new mode of ventilation designed to keep up with patient′s breathing demand and unload work of breathing. In this case report, we have shown that PAV was able to wean off a patient with COPD who had been on the ventilator for 37 days

A Potential Therapeutic Role of Myoinositol in the Metabolic and Cardiovascular Profile of PCOS Iranian Women Aged between 30 and 40 Years

Introduction. Polycystic ovary syndrome (PCOS) is a common disorder in reproductive age. This pilot study investigated the effects of myoinositol (MI) treatment on metabolic and cardiovascular profile in PCOS women over 30 years of age. Methods. Between 2015 and 2016, 50 women with diagnosis of PCOS by the Rotterdam Criteria were included in the study. All women received MI 2 g plus 200 μg of folic acid (Inofolic, Health Parsian, Iran; twice daily) for 3 months. Baseline and 3-month serum samples were taken after an overnight fast to evaluate the insulin resistance index (HOMA-IR), fasting glucose, and the levels of triglyceride, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), homocysteine, systolic blood pressure, and diastolic blood pressure. Participants’ weight was measured before and after treatment and body mass index (BMI) was calculated. Results. The data showed a significant improvement in the serum level of insulin sensitivity and a reduction of cholesterol, LDL, and homocysteine after three months of treatment. Furthermore, blood pressure was significantly reduced in the treated patients. Three participants became pregnant during treatment. Conclusion. Results showed that supplementation with MI and folic acid in PCOS patients over 30 years of age could decrease the risk of cardiovascular problems by normalizing the metabolic profile

Wireless and mobile systems in telemedicine

Background: It is necessary to deploy mobile and wireless systems in healthcare, because they have many benefits for healthcare systems. The objectives of this article were introducing various systems, applications, and standards of the wireless and mobile telemedicine. Material and Methods: This review study was conducted in 2010. To conduct the study, published articles in the years 2005 to 2012, in English with an emphasis on wireless and mobile technologies in health were studied. Search was done with key words include telemedicine, wireless health systems, health and telecommunications technology in databases including Pubmed, Science Direct, Google Scholar, Web of Sciences, Proquest. The collected data were analyzed. Results: Telemedicine system in the ambulance, telemedicine systems in space, telecardiology systems, EEG system, ultrasound system are some types of wireless and mobile systems in telemedicine. PDA-based mobile and wireless telemedicine application, based PDA drug application, and patient tracking application are some of wireless and mobile applications of telemedicine. The most important standards of wireless and mobile telemedicine are HL7, DICOM, SNOMed, and ICD-9-CM. Conclusion: There are many challenges in the wireless and mobile systems in telemedicine, despite the many benefits. Slow speed in sending pictures and video, lack of attention to the privacy in the design of these systems, environmental variables and the number of users during the day are some of these challenges. It is recommended to consider these challenges during the planning and designing of wireless and mobile systems in telemedicine

Effect of commercial (vimang) and hydroalcoholic extract of Mangifera indica (Mango) on gentamicin-induced nephrotoxicity in rat

Objectives: Mangifera indica (Mango) is used in folk medicine for treatment of different types of diseases, and its anti-inflammatory and free radical scavenging activities have been demonstrated. The present study evaluated the effects of commercial (vimang) and hydroalcoholic extract of Mango on gentamicin-induced nephrotoxicity in rat. Materials and Methods: Female Wistar rats were treated with vimang (50 and 100 mg/kg) for 18 days, or hydroalcoholic extract (200 and 400 mg/kg) for 18 days as preventive groups and others with vimang (100 mg/kg) for 8 days, or hydroalcoholic extract (400 mg/kg) for 8 days as treatment groups and also gentamicin (GM) was used at 80 mg/kg/day for eight days, starting from day 10. At the end of treatment, blood and urine samples were taken for measurement of creatinine (Cr) and BUN. The kidney was prepared for histological evaluation. Results: Serum Cr and urea concentrations as well as renal tissue injury increased significantly in GM group compared with the control group. Hydroalcoholic extract of Mango at 200mg/kg was able to reduce plasma Cr and urea concentrations significantly as well as kidney tissue necrosis. Vimang (50 and 100 mg/kg) and hydroalcoholic extract of Mango (200mg/kg) also prevented kidney tissue damage compared with the control group. Conclusion: Mango products were able to improve kidney function in an established model of GM-induced nephrotoxicity in the rat. The beneficial effects of Mango on the rat kidney seem to be dose and time-dependent. However, more investigations are needed to elucidate Mango action on GM-induced renal toxicity

Whole exome sequencing identifies mutations in Usher syndrome genes in profoundly deaf Tunisian patients.

Usher syndrome (USH) is an autosomal recessive disorder characterized by combined deafness-blindness. It accounts for about 50% of all hereditary deafness blindness cases. Three clinical subtypes (USH1, USH2, and USH3) are described, of which USH1 is the most severe form, characterized by congenital profound deafness, constant vestibular dysfunction, and a prepubertal onset of retinitis pigmentosa. We performed whole exome sequencing in four unrelated Tunisian patients affected by apparently isolated, congenital profound deafness, with reportedly normal ocular fundus examination. Four biallelic mutations were identified in two USH1 genes: a splice acceptor site mutation, c.2283-1G>T, and a novel missense mutation, c.5434G>A (p.Glu1812Lys), in MYO7A, and two previously unreported mutations in USH1G, i.e. a frameshift mutation, c.1195_1196delAG (p.Leu399Alafs*24), and a nonsense mutation, c.52A>T (p.Lys18*). Another ophthalmological examination including optical coherence tomography actually showed the presence of retinitis pigmentosa in all the patients. Our findings provide evidence that USH is under-diagnosed in Tunisian deaf patients. Yet, early diagnosis of USH is of utmost importance because these patients should undergo cochlear implant surgery in early childhood, in anticipation of the visual loss