Willingness of WHO staff to work in health emergencies in the African Region: opportunity for phased deployment of staff and ensure continuity of health services

A human resource base that ensures appropriate deployment of staff to emergencies, addressing different shock events in emergencies, without disrupting continuity of service is germane to a successful response. Consequently, the WHO Health Emergencies programme in the African Region, in collaboration with Africa Centre for Disease Control (ACDC) launched the African Volunteer Health Corps (AVoHC) and Strengthening and Utilization of Response Group for Emergencies (SURGE), an initiative aimed at ensuring a pool of timely responders. We explored the willingness of WHO staff to work in emergencies. A call for expression of interest to be part of the Elite Emergency Experts (Triple E) was published on 5th July 2022 via email and was open for 5 weeks. The responses were analyzed using simple descriptive statistics and presented with graphic illustrations. A total of 1253 WHO staff, from all the six WHO regions, cutting across all cadre, applied to the call. The applicants had various trainings and experiences in emergency and have responded to mostly disease outbreaks. Two-third of the applicants were males. This paper did not explore reasons for the willingness to work in emergencies. However, contrary to fears expressed in literature that health workers would not want to work in emergencies with potential for infections, the applicants have worked mostly in infectious emergencies. Literature identified some themes on factors that could impact on willingness of health workers to work in emergencies. These include concerns for the safety of the responders and impact of partners, child and elderly care, as well as other family obligations, which emergency planners must consider in planning emergency response.

Fighting COVID-19 and HIV through community mobilisation: lessons from an integrated approach to the Africa CDC Partnership to Accelerate COVID-19 Testing (PACT) initiative in seven countries

Recent literature has shown how the HIV architecture, including community systems, has been critical for fighting COVID-19 in many countries, while sustaining the HIV response. Innovative initiatives suggest that fostering the integration of health services would help address the colliding pandemics. However, there are few documented real-life examples of community mobilisation strategies responding to COVID-19 and HIV. The African Union and Africa Centres for Disease Control and Prevention (Africa CDC) launched the Partnership to Accelerate COVID-19 Testing (PACT) in june 2020 with the goal of training and deploying one million community health workers across the continent. UNAIDS partnered with Africa CDC to implement the PACT initiative in seven countries, i.e. Algeria, Côte d'Ivoire, Gabon, Ghana, Madagascar, Malawi and Namibia. The initiative engaged networks of people living with HIV and community-led organisations to support two of its pillars, test and trace, and the sensitisation to protective measures against COVID-19 for the most vulnerable populations. It later expanded to improve access to COVID-19 vaccines. Based on the assessment of country projects, this article explains how PACT activities implemented by communities contributed to mitigating COVID-19 and HIV among vulnerable and marginalised groups. This article contributes to a better understanding of the impact of a community-based approach in responding effectively to emerging health threats and provides lessons from integrated COVID-19 and HIV community-led responses.

Risk communication and community engagement in COVID-19: Fighting infodemics among non-governmental/community-based organizations in Africa

As the world battles the latest strain of the coronavirus known as COVID-19 characterized as a pandemic by the World Health Organization (WHO), "infodemics" ­ an excessive amount of (mostly untrue) information about the pandemic that makes it difficult to discern essential information ­ has been identified by the health body as one of the major obstacles to be tackled to win the war against the raging pandemic. In a bid to control spread of the virus, the WHO published a guideline on Risk Communication and Community Engagement (RCCE) to COVID-19, noting these responses are vital for containment. The COVID-19 pandemic is testing and stretching health systems and their ability to effectively communicate with their populations. Failure to communicate accurate public health facts could lead to losses of trust, reputation, economy, and lives. This paper turns its searchlight on nongovernmental and community-based organizations (NGOs and CBOs) in Africa, and how they handle infodemics in an information environment battling not just a health pandemic, but a hoax pandemic too. Methods: The study employed mixed method, with data drawn from Africanbased NGOs and CBOs via online questionnaire and interviews against the backdrop of the Situational Theory of Publics. Findings reveal, based on what NGO/CBO survey respondents report their local clients think, that many at the grassroots still do not believe COVID-19 is real, while others view it as government's scheme to embezzle funds. NGO/CBOs therefore look to WHO and Health Ministries for accurate information. It concludes that RCCE with the public and atrisk populations help reduce confusion and builds trust in the public health guidance community members can take thereby restricting the disease spread as an outcome of the RCCE approach

Child disability and family-centred care in East Africa: Perspectives from a workshop with stakeholders and health practitioners

Our understanding of child disability has undergone major changes over the last three decades transforming our approach to assessment and management. Globally there are significant gaps in the application of these 21st century models of care. There is recognition that economic, cultural, and social factors influence transitions in care and there is need to consider contextual factors.Objectives: A two-day workshop brought together key stakeholders to discuss current models of care and their application in the East African context. This article summarises workshop proceedings and identifies a broadly supported set of recommendations that serve to set a direction for health professionals, families, family-based disability organisations, communities and government. Method: Presentations followed by facilitated round-table sessions explored specific themes with participants reporting their responses communally. Future actions were agreed upon by relevant stakeholders. Results: Many barriers exist to care for children with disabilities in East Africa, including stigma and a lack of human and infrastructural resources. In addition, significant disparities exist with regard to access to medication and specialist care. The International Classification of Functioning framework needs to be translated to clinical practice within East Africa, with due recognition of the importance of family- centred care and emphasis on the life course theory for disability care. Family- centred care, educational initiatives, advocacy on the part of stakeholders and involvement of government policymakers are important avenues to improve outcomes. Conclusion: Further education and data are needed to inform family-centred care and multidisciplinary team implementation across East African care contexts for children with disabilities.

Facteurs de risque et étiologies des AVC de l'adulte jeune au CHU de Bogodogo à Ouagadougou / Risk factors and etiologies of stroke in young adults in Bogodogo university hospital, Ouagadougou

Introduction: Les accidents vasculaires cérébraux (AVC) sont des pathologies graves survenant le plus souvent chez le sujet âgé. Le but de ce travail était d'étudier les facteurs de risque et les étiologies de l'AVC de l'adulte jeune. Patients et méthodes : Il s'est agi d'une étude transversale et rétrospective incluant tous les sujets d'âge compris entre 15 et 45 ans, hospitalisés pour AVC dans le service de neurologie du CHU de Bogodogo entre le 1er Avril 2017 et le 31 Mars 2019 et ayant un dossier complet. Résultats : Quarante-quatre cas d'AVC concernaient les sujets jeunes, soit 8,46% de l'ensemble des AVC. On notait 59,1% d'AVC ischémique et 40,9% d'AVC hémorragique. L'âge moyen était de37,45± 5,94 ans. Le sex-ratio était 2,14. La sédentarité (72,22%), l'HTA (59,09%) et le diabète (25%) étaient les principaux facteurs de risque. L'étiologie a été retrouvée chez 77,27% des patients. Il s'agissait principalement de l'athérosclérose et les cardiopathies emboligènes pour l'AVC ischémique et de l'HTA pour l'AVC hémorragique. Conclusion: Les AVC du sujet jeune sont relativement peu fréquents au CHU de Bogodogo. Une prévention des facteurs de risque vasculaire permettrait d'éviter une augmentation de leur fréquence

Introduction: Stroke is a common and serious disease occurring most often in the elderly. The aim if our study was to describe risk factors and causes of stroke in young adults. Patients and methods: This were a retrospective study including patients whose age was between 15 and 45 years, hospitalized in the neurology department of the Bogodogo University Hospital for stroke between April 1, 2017, and March 31, 2019. Results: Forty-four stroke cases involved young adults, it represented 8.46% of total stroke. Among those cases, 59,1% was ischemic stroke and 40,9% was hemorrhagic stroke. The Mean age was37,45± 5,94 years. The sex-ratio was 2,14. Physical inactivity (72,22%), high blood pressure (59,09%) and diabetes (25%) were the main risk factors. etiologies were found in 77,27% of cases. They were dominated by atherosclerosis and cardio embolism in ischemic stroke, and by high blood pressure in hemorrhagic stroke. Conclusion: Stroke in young adults at Bogodogo University Hospital is relatively infrequent. Prevention of risk factors would prevent an increase in its frequency

Contemporary prevalence and predictors of anxiety among patients living with HIVAIDS in Ghana

Objectives: To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana. Design: The study employed a cross-sectional design. Setting: The study was conducted in the outpatient HIV clinic of a tertiary hospital. Participants: Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study. Interventions: Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors. Main outcome measure: Proportion of PLWHA who had HADS score of ≥8 Results: Overall prevalence of anxiety was 61.0% (95%CI: 56.6 ­ 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 ­ 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 ­ 2.38) and depression (aOR: 13.62, 95%CI: 7.91 ­ 23.45) were independently associated with anxiety. Conclusion: In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety

Conceptualization and practices in digital health voices from Africa

This paper presents voices from Africa on digital health in Africa. These voices were gleaned during interviews and an online, focus group session in May 2020, during which 30 experts across Africa, among others from the South, were asked about their experiences and observations on the conceptualization of, and practices in, digital health in their respective communities and countries. Extensive input was provided, both orally and textually. The quotes gathered and presented in this paper indicate that there is a distinct need for the respectful co-development of digital health interventions in Africa. In addition, the quotes show how a one-size-fits-all solution approach does not exist, it is not a solution to Africa. Further, the community-focus, fit, and fragmentation of existing activities digital health interventions is questioned. The narratives provide a rich resource indicating capable and local agency and the need to address power-differences in international health development

Atlas of African health statistics 2022: Health situation analysis of the WHO African Region

The population of the World Health Organization's (WHO) African Region was estimated to be 1 120 161 000 in 2020 and about 14.4% of the world's population of 7 758 157 000. It was 8 billion in 20211 . It is the third largest population among the WHO regions after South-East Asia and the Western Pacific. Between 2019 and 2020, the population differential was equivalent to that of a state of more than 28 million inhabitants. The five most populated countries account for more than 45% of the Region's population. Among these, Nigeria and the Democratic Republic of the Congo represent about 50% of the population of the West African and Central African subregions, respectively, and Ethiopia represents about 20% of the population of the East and Southern Africa subregions. The average annual population growth in Africa was 2.5% in 2020. If the heterogeneity of the population growth between the regions of the world and between countries in the same subregion is considered, countries from and East and Southern Africa subregions seem to have lower population growth rates than countries in other large subregions, which show significantly higher increases. The current population density of Africa is low, estimated to be 36 inhabitants per km2 for the whole continent. However, many areas are uninhabitable and some countries have relatively large populations. High population density is a concern that must be addressed through policies, because it could generate surges and high concentrations of populations in mega cities and urban slums, which can be an issue when it comes to accessing various qualitative services. Gross domestic product (GDP) reflects a country's resources and therefore its potential to provide access to services to its people, particularly health services. This dynamic creates a circle, with healthier people going to work and contributing to the production of wealth for the benefit of the country. The most vulnerable people live from agriculture in rural areas, or in conflict-affected states. Difficulties in accessing health services, low education and inequalities between men and women are additional obstacles to poverty reduction. The population of sub-Saharan Africa is expected to almost double over the next three decades, growing from 1.15 billion in 2022 to 2.09 billion in 2050. The world's population is expected to grow from 7.94 billion at present to 8.51 billion in 2030 and 9.68 billion in 2050. The demographic dividend2 for African countries will emanate from the acceleration of economic growth following a de crease in fertility with a change in the structure of the age pyramid where the active population, that is those aged 18­65 years, will be more important, reaching a certain optimum to make positive the ratio between the population able to finance health and education systems and the population that benefits from these systems. This is the human capital for development at a given moment. The demographic dividend appears to be an opportunity and an invitation to action, but it is also a real challenge, that of creating sustainable jobs to generate the development to activate the economic growth lever.

Atlas of African Health Statistics 2022: Health situation analysis of the WHO African Region - Country profiles

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Atlas of African health statistics 2022: health situation analysis of the WHO African Region ­ summary report

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Atlas des statistiques sanitaires africaines 2022: analyse de la situation sanitaire de la Région africaine ­ rapport de synthèse

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Current use and perceived barriers of emergency point-of-care ultrasound by African health care practitioners

Introduction: The African Federation of Emergency Medicine (AFEM) recommends the use of emergency point-of-care ultrasound (ePOCUS) as a core skill for health care practitioners in Africa. The study explored the use of ePOCUS by health care practitioners among AFEM members who work across Africa. Methods: An anonymous online survey was distributed to individual members of AFEM and affiliated organisa-tions. The questionnaire was tested by the AFEM Scientific Committee for potential content modifications priorto distribution. Summary statistics are presented. Results: Of the 220 participants that were analysed, 148 (67.3%) were using ePOCUS. The mean age was 36 years;146 (66%) were male; and 198 (90%) obtained their primary medical qualification in Africa. In total, 168 (76%) were doctors, and most participants (n = 204, 93%) have worked in Africa during the last 5 years. Reasons for not using ePOCUS mainly related to lack of training and problems with ultrasound machines or consumables. Most ePOCUS users (116/148, 78%) attended courses with hands-on training, but only 65 (44%) participants were credentialed (by 18 different organizations). The median score for self-perceived level of ePOCUS skills was 75 in credentialed users versus 50 in those that were not credentialed. Ultrasound in trauma was the most frequently used module (n = 141, 99%), followed by focused cardiac assessment (n = 128, 90%) and thoracic (including lung) assessment (n = 128, 90.1%). The FASH-module (Focused Assessment with Sonography for HIV/TB) was the least used (n = 69, 49%). Conclusion: Access barriers to ePOCUS training, mentorship, equipment and consumables are still relevant in Africa. The low credentialing rate and the potential discordance between local burden of disease and ePOCUStraining requires further investigation.

A qualitative synthesis of the impact of infertility on the mental health of African women

Infertility is a reproductive problem that affects all gender, race, or social class. In many African countries, the burden of infertility is usually associated with economic, psychological, and socio-cultural factors. This review aimed to explore the factors that impact the mental health of African women with primary infertility. A qualitative evidence synthesis was used to summarise and analyse primary qualitative studies focused on the impact of primary infertility on African women. Seventeen studies met the eligibility criteria and were included in the review. The review found that social pressure, stigma from family and community members, and financial constraints led to psychological distress. In addition, social stigma also led to marital problems which led to significant psychological distress and low self-worth, especially on the wife. Recommendations to reduce stigma among African infertile women were as follows: advocacy and community mobilisation, education by health professionals, and holistic person-centred care. An intersectional approach to inform public health and social policy was also suggested.

Cancer de la prostate chez le sujet de race noire en Côte d'Ivoire / Prostate cancer in the black subjectin Côte d'Ivoire

RÉSUMÉ Contexte. L'incidence croissante de l'adénocarcinome prostatique en Afrique noire pose la problématique de sa caractérisation tant au niveau épidémiologique, clinique que thérapeutique. But : Identifi er le profi l clinico-biologique et les options thérapeutiques actuelles dans le service de cancérologie du CHU de Treichville. Méthodes : Etude rétro et prospective à visée descriptive sur une période de 24 mois. Cette étude a permis de colliger 110 patients de race noire avec adénocarcinome de la prostate histologiquement confi rmé. Résultats : L'âge moyen était de 57 ans. Toutes les classes sociales (basses, moyennes et hautes) étaient concernées dans respectivement 28, 37 et 35% des cas. La notion de cancer familiale concernait 17,7% patients. Les signes cliniques étaient bruyants et représentés par un syndrome obstructif du bas appareil urinaire. Le PSA était supérieur à 50 ng/ml dans 71% des cas. Dans 95% des cas nos patients consultaient à un stade localement avancé ou métastatique avec l'os comme site préférentiel (68% des cas). Le Score de Gleason était supérieur à 7 dans 70% des cas. L'hormonothérapie était l'option thérapeutique la plus utilisée (60% des cas). Elle s'associait à la chimiothérapie dans 15,5% des cas. Aucune réponse complète n'a été obtenu chez les patients à haut risque de d'Amico. La résistance à la castration est apparue précocement dans un délai moyen de 9 mois. Conclusion. L'adénocarcinome prostatique survient dans notre contexte chez des patients relativement jeunes avec des caractéristiques histo pronostiques péjoratives.

African countries established COVID-19 testing in one month: Here's how they did it

Background: As a novel and deadly acute respiratory syndrome, which later became known as coronavirus disease 2019 (COVID-19), spread beyond China in late January 2020, there were no laboratories in Africa that could test for the disease. However, in early March, just over a month later, 42 African countries had developed the expertise and resources to perform COVID-19 testing. Our goal was to document this public health success story, learn from it, and use it to inform future public health action. Intervention: Three groups were primarily responsible for establishing COVID-19 testing capacity in Africa. The first group comprised early test manufacturers who reacted with incredible speed and ingenuity early in the pandemic, such as the German company TIB MolBiol that developed a molecular test for COVID-19 before the SARS-CoV-2 genome sequence was available. The second group included private and public donors such as the Jack Ma Foundation, and the last were the coordinators of the rollout, such as the World Health Organization and the Africa Centres for Disease Control and Prevention (CDC). Lessons learnt: The first lesson was that speed is critical, especially during a crisis. It was also demonstrated that being a predictable and transparent trusted institution opens doors and improves effectiveness. Africa CDC, which was only three years old, was able to secure significant resources from external partners and rapidly build substantial testing capacity within Africa because it is a trusted institution. Recommendations: Low- and middle-income countries must build local trusted institutions to better prepare for public health challenges

Emerging statistics on the epidemiology of COVID-19: Making prevention in pregnancy less grievous than the disease

Background:Pregnant women are a vulnerable group to the COVID-19 infection; although it is expected that adaptive changes of pregnancy put them at increased risk of adverse outcome from any respiratory tract infection, interventions for the COVID-19 may put them in more danger. Nigeria is one of the leading countries with very poor maternal mortality indices and many other sub-Saharan African nations are in the same boat. Contingency plans need to beput in place to prevent precipitous deterioration in mortality rates occasioned by the dreaded SARS-Cov-2 pandemic. This mini-review of literature and WHO global statistics is aimed to determine the trends in COVID-19 transmission and mortality rates to provide evidence-based information that may enable governments to tailor their interventions to the peculiar needs, of sub-Saharan African populations.Main body:Emerging epidemiological trends on transmission and mortality within Africa and the worst affected regions of the world suggests better outcomes of this infection in sub-Saharan Africa, than in other regions of the world. Also, present data allude to similar outcomes between pregnant and non-pregnant women. The present containment measures of isolation and quarantine, including city-wide lockdowns, may put pregnant women at higher risk of death from other causes rather than COVID-19. The danger posed, is the limitation of access to emergency obstetric care services when pregnant women develop non-COVID-19 complications of pregnancy.Conclusion:The COVID-19 pandemic has lower local transmission rates and fatality in Africa, the region where the virus arrived last. While special efforts should be geared at shielding the elderly and infirm from contracting the infection, preventive measures in pregnant women must allow for access to emergency obstetric care to forestall iatrogenic adverse maternal outcomes

PMTCT Option B+ 2012 to 2018 ­ Taking stock: barriers and strategies to improve adherence to Option B+ in urban and rural Uganda

Since 2012, PMTCT Option B+ has been recommended by the World Health Organization to reduce vertical transmission but numerous adherence challenges remain. We conducted a qualitative study at baseline using six focus group discussions and 14 in-depth interviews to explore knowledge, beliefs, attitudes and challenges towards the Option B+ strategy for PMTCT among HIV-infected pregnant and post-partum women and health workers engaged in Uganda's national Option B+ PMTCT programme. Data were analysed using a thematic approach to capture latent and manifest content with the social ecological model as a theoretic foundation in order to make contextual sense of key stakeholders' needs for an effective Option B+ intervention. Overall, among all study participants, we found multi-level barriers to adhering to Option B+ cutting across all levels of the social ecological model. In line with the model, our study revealed barriers at personal, relational, organizational and societal levels. Some personal beliefs such as that the baby's health is more important that the mother's, organizational (negative attitudes and behaviour of health workers), structural such as poverty, work conflicts, fear and lack of disclosure related to community stigma were all critical obstacles to women adhering to the Option B+ programme. We found that both health workers and participants in the programme have a relatively clear understanding of the benefits of adhering to their treatment; though a more nuanced understanding and thus emphasis in counselling on side effects, is critical to helping patients adhere

Disability and functioning in primary and secondary hip osteoarthritis in Benin

Background: In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis. Objectives: The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis. Method: This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou. Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a t-test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status. Results: Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification. Conclusion: Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life