Incidental finding of COVID-19 infection amongst staff at a primary care facility in Ghana

The COVID-19 pandemic has affected nearly every country worldwide and all African countries. The issue of healthcare workers (HCWs) contracting the disease is a growing concern in Ghana, because of the risk of spreading infections amongst themselves and to vulnerable patients in their care. This article illustrates how 14 staff at the Korle Bu Polyclinic/Family Medicine Department were incidentally found to be Covid-19 positive with most of them being asymptomatic. This observation led to a modification of the personal protective equipment (PPE) used by clinical staff when attending to patients. Furthermore, this finding suggests that a different criteria or guideline may be needed for testing of HCWs during a pandemic where a significant proportion of infected people are asymptomatic. We conclude that in the primary care setting HCWs must be ready to see all the following cases safely: routine patients, asymptomatic COVID-19 patients and suspected COVID-19 patients

Coping with the supply-side effects of free maternal healthcare policies in seven sub-saharan african countries: a systematic review

Free maternal healthcare policies (FMHP) result in enormous supply-side effects on care delivery in sub-Saharan Africa (SSA). This review synthesises the mechanisms adopted by supply-side actors to cope with the effects of FMHP and the results of coping mechanisms on policy objectives in seven SSA countries. We searched bibliographic databases for articles published in English for research that reported supply-side effects of FMHP, coping mechanisms, and effects of various coping mechanisms on attainment of reform objectives. Out of 215 studies identified, nine qualified for inclusion. Selected studies were exploratory in design and based on either mixed or qualitative methods. While local health system authorities and health facilities coping mechanisms that were intended to enhance implementation, facility managers and staff engaged in self-interest adaptation decisions and behaviours. Lack of explicit policy commitment to enhancing organisational and managerial capacity of local health authorities contribute to sustaining negative supply-side effects and adverse coping mechanisms. Without due consideration to governance and health system strengthening, FMHP are prone to perverse outcomes that undermine intended benefits. Context-specific empirical studies are needed to further conceptualise the supply-side effect ­ coping mechanism ­ consequential effect nexus of the policy

Perceived stressors of oral hygiene students in the dental environment

Background. University students are exposed to a multitude of stressors that may impact on their performance. The nature of health sciences education generally involves early engagement with patients and communities; which may add to the stressors inherent to university life. There is sparse information on stressors in the oral hygiene educational environment. Objective. To determine perceived stressors and the level of burnout among oral hygiene students at the University of the Western Cape; Cape Town; South Africa. Method. A descriptive; cross-sectional study design was used. The study sample included all students in the Bachelor of Oral Health (BOH) degree during 2012 (N=89). A self-administered questionnaire was used to gather data. Three parameters were measured; i.e. (i) demographic characteristics; (ii) perceived sources of stress; using a modified Dental Environment Stress (DES) questionnaire; and (iii) burnout; using the Maslach Burnout Inventory (MBI). Results. Respondents were mostly female (74%) and primarily in the 18 - 25-year age group (92%). First- and 2nd-year students identified fear of failing and study load as major stressors. Stressors related to a lack of basic needs were identified as major stressors by 25% of 1st-year students. Third-year students identified clinical quotas; supervision and patients being late as major stressors. MBI scores indicated that students were not at risk forburnout; however; most students (66.2%) scored high on emotional exhaustion (EE). Conclusion. Oral hygiene students identified stressors in their learning environment. There was a progressive increase in EE across academic years. The results suggest that interventions should be tailored for specific academic year groups

Community-based study of circumcision practices in Nigeria

Background: Circumcision practice around the world has various implications and has generated a lot of debate about the pros and cons of the practice. Nigeria is one of the countries where male and female circumcision practice still occurs however, there has been claim of reduction in female genital cutting. Congregational or 'group' circumcision prevails in some communities as a means of upholding traditions and commemoration of festive period. Objective: To determine the pattern of circumcision practice and identify factors affecting the practice in Ilorin community. Materials and Methods: The study was a descriptive, cross sectional study conducted among parents of under-5 children of both the sexes using pre-tested, semi-structured questionnaires, which were administered to the respondents by trained research assistants over a six-week period. Clinical examination of genital area in index child of each respondent was done by a pediatric surgeon, who was the principal investigator. Results: Three hundred and ninety three (93%) respondents completed the questionnaire and the same number of index children's external genitalia was examined by the pediatric surgeon. The mean age of respondents was 33.2±9.3 years, and the main source of family income was private enterprises and civil services. The circumcision status of fathers was 100%, mothers, 65.6%, and overall female-child circumcision rate was 46.7%. Though, most of the index children were delivered at health centers (72.3%), the circumcisions were performed at almost equal frequencies by traditional circumcisionists (39.8%) and doctors (39.2%), with more than half of the circumcision being done outside the hospital. The mean age at circumcision was 22 ±0.69 months, with 73.9% of girls as against 91.7% boys being circumcised by the age of five years. Family choice was the main determinant of the age at circumcision and the circumcisionist. Female circumcision was done by traditional circumcisionist, nurses, and doctors in 1 in 4, 1 in 5, and 1 in 10 cases of circumcision, respectively. Traditional open (classical) circumcision technique was mostly used (40.4%), followed by Plastibel TM (ring type) (32.6%), and 'group' circumcision was practiced among 41.2% of respondents. Post-circumcision complications were seen in 116 (33.7%) of circumcised children examined. Conclusion: Circumcision practice in Ilorin is still higher among the traditional circumcisionists, despite of high hospital delivery. Female circumcision and 'group' circumcision were also being practiced, using mainly the traditional open circumcision technique. The high rate of circumcision complications indicate the need for proper enlightenment and retraining of health care providers and traditional circumcisionists on the safe methods available. The government should involve the religion and opinion leaders in the community to assist in the prevention of negative and harmful traditional practices including female circumcision

Invasive Salmonellosis in Malawi

The incidence of invasive salmonellosis has increased among children and HIV-infected adults in Malawi. This has been associated with the emergence of drug resistance in the non-typhoidal Salmonella serovars Enteritidis and Typhimurium. In contrast; S. Typhi isolates have remained fully sensitive to commonly used antibiotics and the estimated incidence of typhoid fever; although still present; has fallen slightly among both adults and children. Infection with S. Typhi is not closely associated with underlying immuno- suppression but it is possible that the non-typhoidal Salmonellae have adapted to the person-person human transmission niche in this frequently immunosuppressed population. The huge burden of invasive salmonellosis in Malawi; the high associated mortality; and the recent emergence of drug resistance emphasise the need for a better understanding of the epidemiology and the need for vaccine development

The epidemiology of respiratory disease in Zimbabwe

This review of the burden of respiratory diseases in children and adult Zimbabweans is based on limited available literature and highlights a need for more descriptive epidemio- logical studies. In children; the commonest reported causes of respiratory mortality were acute pyogenic pneumonia; Pneumocystis carinii pneumonia; and tuberculosis; with different patterns of diseases evident between HIV-positive and HIV-negative children. Asthma and other atopic conditions are common but under-reported due to a predomi- nance of publication on HIV-related subjects. In adults; exposure to indoor air pollution due to burning of biomass fuels is probably associated with acute respiratory infections; asthma; chronic obstructive pulmonary disease; lung cancer; and nasopharyngeal and laryngeal cancers in Zimbabwe as in other regions. These conditions also have other common risk factors including malnutrition and tobacco smoking but the prevalence rates of these conditions and their associations with risk factors are not known. In adults with chronic cough; tuberculosis is the most common diagnosis among HIV infected adults but lower respiratory tract infections and asthma were more common among HIV- negative patients. Factors associated with tobacco smoking in Zimbabwe are discussed

The Patient With Excessive Worry

Worry is a normal response to uncertainty. Education; empathetic support; reassurance; and passage of time usually ameliorate ordinary worries. However; these common-sense strategies for dealing with transient worries often prove ineffective for patients with excessive worry; many of whom meet the criteria for disorders in the Diagnostic and Statistical Manual of Mental Disorders; 4th ed. Evidence-based treatments for such disorders can assist family physicians in management of persistent worry as a self-perpetuating habit across diagnostic categories. Antidepressants and cognitive behavioural therapy are effective treatments for various disorders characterised by excessive worry. Cognitive behavioural strategies that may be adapted to primary care contacts include education about the worry process; repeated challenge of cognitive distortions and beliefs that underpin worry; behavioural exposure assignments (e.g.; scheduled worry periods; worry journals); and learning mindfulness meditation

Abundances and nocturnal activities of phlebotomine sandflies (Diptera : Psychodidae) in termite hills and animals burrows in Baringo District; Kenya

The abundance of phlebotomine sandflies was studied in a leishmaniasis endemic area in Baringo District; Rift Valley Province; Kenya. This was based on sandfly behaviors at night in their natural habitats of termite hills and animal burrows. Sandflies were collected with an entry-exit trap which has a sieve fixed at the middle to control sandfly movements. Flies were trapped from 1800-0600 hours. Phlebotomus martini (Parrot) were significantly more abundant in termite hills than in animal burrows (P 0.05). Phlebotomus duboscqi (Neveu-Lemaire) were found to favour animal burrows more than termite hills (P 0.05). Nocturnal movements and activities showed that the majority of the sandflies were exiting from termite hills and animal burrows from 1800-2400 hours while from 2400-0600 hours; the majority of the sandflies were entering termite hills and animal burrows (P0.05). Sergentomyia (Theodor) species showed mixed preferences for these two habitats. Sergentomyia schwetzi (Aldler; Theodor et Pam favoured termite hills more than animal burrows but S. clydei (Sinton) showed great preference for animal burrows. The nocturnal activities or preferences of habitats by phlebotomine sandflies have epidemiological significance in that control measures can be directed to these habitats with a certain degree of accuracy for the vectors of visceral and cutaneous Leishmaniasis in Kenya

Clinical diagnostic imaging in - Ascites

An appropriate sequence of diagnostic imaging procedures which will permit a rapid; accurate diagnosis with the least number of tests and with minimum expense and disconfort to the patient. Ascites if used in the wider sense as free fluid collection within the intraperitoneal cavity; should include serous fluid; blood (bloody); urine; pus; chylous as well as galliger Ascites. In the majority of cases the clinical and laboratory evaluation of patients with ascites is sufficient to reveal the cause of fluid accumulation. However even when the cause of asctes seems pretty obvious; it is important to look for other diseases that might supervene. For example ascites by cirrhosis complicated by occult hepatoma

Clinical diagnosis imaging in intestinal obstruction

In these days of sophisticated technology; the diagnosis of intestinal obsruction (and pseudo-obstruction) still depends almost entirely on plain X-rays and barium studies. Although rigid routines (and old myths) interfere with the interpretation of plain X-ray; nevertheless; the first step in intestinal obstruction is a series of plain X-rays without contrast. An erect; lateral left decubitus (2) supine and chest X-ray (3); (4); should be obtained because of several reasons. One of these reasons is the fact that a chest X-ray is necessary in all plain X-ray series for obstruction; in order not to be trapped into a wrong diagnosis of mechanical small bowel obstruction in pneumonia (not even only those limited to the lower lobes) and this; especially in aging adults and young children

Application of multiple methods to study the immunization programme in an urban area of Guinea

During 1988-89, studies were conducted to evaluate the immunization system in Conakry, Guinea. The first, a health facility survey, found that health staff screened the vaccination status of only 30% of children who presented for curative care. A sterile syringe and needle were used for less than half of the injections. In the second survey, key informant interviews with vaccinators and health centre chiefs showed that there were minimal lines of communication between health workers and the community, but that health workers did not perceive this to be a problem. Focus group discussions in the community revealed a high level of general knowledge about vaccine-preventable diseases. However, mothers did not know how many vaccinations their children should receive or by what age they should be completed. They complained of long waiting times in health centres, the high costs of vaccination, poor rapport with health workers, and the occurrence of abscesses after vaccination. The final study, a "knowledge, attitudes, and practice" community survey, showed that missed immunization opportunities and inappropriately timed vaccinations reduced potential vaccine coverage by almost 30% among children with vaccination cards. Higher socioeconomic status, delivery in hospital, and whether mothers perceived the vaccinations to be affordable affected whether the child began the immunization series. Once a child had entered the immunization system, completion of the series was determined by the mother's education level, employment status, and experience with vaccination services