After action review of the COVID-19 pandemic response in North West province, South Africa

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused coronavirus disease 2019 (COVID-19) pandemic with major disruptions globally. Northwest Province Department of Health (NWDoH) in South Africa set up comprehensive epidemiological emergency response plans for preventing, finding, containing and stopping the spread of COVID-19 in accordance with the National Disaster Management Act. Objectives: This After-Action Report (AAR) describes the provincial response to the pandemic from September 2020 to October 2022. Method: The AAR was conducted using the World Health Organization AAR methodology. Focus groups discussed five items: coordination, leadership and governance; epidemiology, surveillance and laboratory; case management and continuity of essential services; risk communication and community engagement and COVID-19 vaccination. Results: The timely establishment and activation of provincial intergovernmental and intersectoral coordinating structures led to effective coordination, resource mobilisation, leadership, decision-making and intervention. The effective communication in the department and other stakeholders resulted in improved surveillance data quality, timelier response and increased ownership of data. Dissemination, training and implementation of case management protocols ensured standardised case management. The multi-channel information dissemination targeting different audiences empowered people with real-time knowledge on the infection and encouraged health-seeking behaviours. Conclusion: The AAR demonstrated the importance of coordinated epidemiological, laboratory and communication response that requires significant public health reserve capacity in peacetime for rapid expansion in an emergency. Contribution: This review contributes to the body of knowledge emerging from the COVID-19 pandemic and provides guidance on enhanced public health response to future emergencies.

Choanal atresia: Diagnosis and management

Objective: Choanal atresia (CA) is a rare congenital malformation caused by the obliteration of the posterior choanae by an atretic plate. The aim of our study is to describe the diagnosis and management modalities of CA and to determine the factors associated with recurrence. Materials and methods: This is a retrospective study based on the medical records of patients with CA managed in our department in the period between 2002 and 2021. We studied the clinical features and management modalities of each patient. For patients who developed a recurrence, we determined the factors associated with recurrence based on a bivariate analysis. Results: We studied the medical records of 26 patients with either a bilateral (n=8) or a unilateral (n=16) form of CA. The median age at surgery was two days for bilateral forms and 5 years and 4 months for unilateral forms. At computed tomography scan, CA was mixed (n=20), bony (n=4) or membranous (n=2). All patients underwent intranasal endoscopic surgical treatment using cold instruments alone in membranous forms and combined to the drilling of the atretic plate in bony and mixed forms. The surgical management included the resection of the posterior part of the vomer bone and the placement of nasal stents in 10 and 16 patients respectively. We recorded 6 cases of recurrence requiring a surgical re-intervention. The presence of associated cranio-facial malformations was the only factor associated with recurrence (p=0,001). Conclusion: Choanal atresia diagnosis was based on nasal endoscopy and CT scan. Surgical treatment using transnasal endoscopic approach was an effective and safe technique. Associated local malformations was a factor associated with re-stenosis

Incidences de la présence des garde-malades sur la prise en charge médicale des patients. Etude menée au Centre Hospitalier Universitaire de Brazzaville

La gestion du malade dans l?univers hospitalier implique non seulement le personnel soignant, mais aussi d?autres acteurs sociaux encore moins connus des gestionnaires des structures hospitalières et des catégories socio professionnelles y évoluant. Parmi ces acteurs encore moins connu, il y a le garde-malade faisant partie du personnel hospitalier en charge de la prise en charge des patients en milieu hospitalier. Cependant au Centre Hospitalier et Universitaire de Brazzaville en République du Congo, les garde-malades sont constitués des parents, amis et connaissances dont la représentation est importante dans cet univers hospitalier. Cette représentation aussi remarquable soit ­ elle, interpelle plus d?un observateur au point de s?interroger sur les raisons à l?origine de cette présence. Notre étude répond à la logique qui est celle de tenter de comprendre et d?analyser ce phénomène devenu très inquiétant. Ce phénomène est donc à lire dans la perspective de la complexité des réalités sociales qui s?expliquent à partir des déterminants socio culturels, fondements de la vie sociale. Aussi, la faiblesse des services sous tutelle du C.H.U-B et la culture bantoue, laquelle repose sur la solidarité mécanique qui, appelle à la cohésion sociale, constituent des facteurs qui expliquent ce phénomène. A cet effet, une observation participante a été effectuée dans cette structure hospitalière. Celle-ci a permis de relever une influence importante qui, pour diverses raisons réponde aux préoccupations des malades. Cette étude présente trois intérêts : scientifique, social et personnel. D?abord, elle montre la difficulté en ressources humaines qui se traduit par la sous représentativité des catégories socio professionnelles qui, contribueraient à résoudre la question de l?effectivité de prise en charge du malade. Ensuite, l?étude présente un autre intérêt qui met en exergue la cohésion sociale qui, s?exprime à travers la chaine de solidarité dont la famille est le maillon. Le dernier centre d?intérêt est personnel. Il met en relief un aspect culturel très intéressant, celui de l?homogénéité et de la dynamique des rapports des acteurs impliqués dans la gestion du malade. Quoi qu?il en soit, le garde-malade joue un rôle de premier plan dans la gestion du malade. Il accompagne le personnel soignant, car partageant le même environnement social que le malade. Aussi, sa visibilité nécessite un encadrement juridique pour lui donner une véritable identité.

The management of the patient in the hospital word involves not only the nursing staff, but also other social actors even less known to the manager of hospital structures and socio-professional categories. Among these actors even less known, there is the nurse who is part of the hospital staff in charge of the care of patients in hospital environment. Howerver at the Brazzaville Hospital and University Center in the Republic of Congo, the nurses are made up of relatives, friends and acquaintanees whose representation is important in this hospital environment. This representation, as remarkable as it is, calls out to more than one observer to the point of questioning the reasons behind this presence.Our study reponds to the logic of trying to understand and analyze this phenomenon, which has become very worrying. This phenomenon should therefore be read in the perspective of the complexity of social realities which can be explained on the basis of socio-cultural determinants, the foundations of social life. Also, the weakness of the services under the supervision of the C.H.U-B and of the Bantu culture, which is based on mechanical solidarity, which, calls for social cohesion, are factors that explain this phenomenon. To this end, a participant observation was carried out this hospital structure. This made it possible to identify an important influence which, for various reasons, responds to the concerns of patients. This study has three interests: scientific, social and personal. First, it shows the difficulty in human resources which result in the representativeness of the socio-professional categories which would help to resolve the issue of effectiveness of patient care. The study presents another interest which highlights the social cohesion which is expressed through the chain of solidarity of which the family is the link. The last area of interest is personal. It highlights a very interesting cultural aspect, that of the homogeneity and dynamics of relationships of the actors involved in the management of the patient. In any case, the nurse plays a leading role in management of the patient. He supports the nursing staff, because they share the same social environment as the patient. Also, its visibility requires a legal framework to give it a real identity

Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020­May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2(0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

Aspects épidémiologiques de la malnutrition aiguë sévère au centre nutritionnel et thérapeutique interne (CNTI) du District de Santé de Tcholliré

La malnutrition reste la principale cause de morbidité et de mortalité sous-jacentes infantiles dans le monde. Au Cameroun, elle sévit encore avec acuité particulièrement dans les trois régions septentrionales et dans la région de l'Est. La présente étude vise à analyser les aspects épidémiologiques de la malnutrition aiguë sévère infantile au Centre Nutritionnel et Thérapeutique Interne du District de santé de Tcholliré (CNTI) de 2010 à 2013. Il s'agit d'une étude transversale rétrospective réalisée dans le Centre Nutritionnel et Thérapeutique Interne du District de Santé de Tcholliré. Etait inclus dans cette étude, tout enfant âgé de moins de 60 mois. A l'aide d'une grille constituée des variables sociodémographiques, anthropométriques, cliniques, thérapeutiques et l'évolution, nous avons compulsé le registre des patients consultés et hospitalisés pour malnutrition aiguë sévère dans ledit centre sur une période de 35 mois (juin 2010 à avril 2013). La saisie, le traitement et l'analyse des données ont été réalisées à l'aide des logiciels ENA, Excel et SPSS. Sur 155 cas d'hospitalisation pour malnutrition aiguë sévère dans ce centre, 107 cas de malnutrition aiguë sévère infantile représentant 69,03% des cas ont été recensés. L'âge moyen des patients était de 19 ± 12 mois et la tranche d'âge la plus touchée était celle de 12 à 24 mois avec 57%. Le sexe masculin était majoritairement atteint (51,4%) avec un sex-ratio de 1,06 (55 H/52 F). Un patient malnutris sévère admis avec l'indice poids pour taille inférieur à -2z scores avait 9,27 fois plus de chance de guérir qu'un patient admis avec l'indice poids pour taille inférieur à -3z scores (OR= 9,27 IC95% [1,57-64,67] ; p= 0,014). Par ailleurs, l'hospitalisation d'un patient malnutri à plus de 10 jours au CNTI de Tcholliré était statistiquement associée à un risque réduit de décès (p = 0,000). La létalité hospitalière imputable à la malnutrition sévère était de 9,30%. Malgré les efforts consentis par les différents acteurs, la malnutrition reste une menace pour la survie des enfants de moins de 5 ans dans le District de Santé de Tcholliré. La sensibilisation des populations et la mise en œuvre des programmes intégrés de lutte contre la malnutrition permettront l'amélioration de l'état nutritionnel des enfants

National Scale-Up of Integrated Community Case Management in Rural Ethiopia: Implementation and Early Lessons Learned

Background. Although under-five mortality in Ethiopia has decreased 67in the past two decades; many children still die from preventable or treatable conditions; mainly pneumonia; newborn problems; diarrhea; malaria and malnutrition. Most of these deaths can be avoided with timely and appropriate care; but access to and use of treatment remains inadequate. Community health workers appropriately trained; supervised; and supplied with essential equipment and medicines; can deliver case management or referral to most sick children. In 2010; Ethiopia added pneumonia to diarrhea; malaria and severe acute malnutrition; targeted for treatment in the integrated community case management (iCCM) strategy. Purpose. This article describes the national scale-up of iCCM implementation and early lessons learned. Methods. We reviewed data related to iCCM program inputs and processes from reports; minutes; and related documents from January 2010 through July 2013. We describe introduction and scale-up through eight health system components. Results.The government and partners trained and supplied 27;116 of the total 32;000 Health Extension Workers and mentored 80 of them to deliver iCCM services to over one million children. The government led a strong iCCM partnership that attracted development partners inimplementation; monitoring; evaluation; and research. Service utilization and weak supply chain remain major challenges. Conclusion:Strong MOH leadership; policy support; and national partnerships helped successful national iCCM scale-up and should help settle remaining challenges

Performance of Ethiopia's Health System in Delivering Integrated Community-Based Case Management

Background. Analyzing complex health programs by their components and subcomponents serves design; documentation; evaluation; research; and gap identification and prioritization. In 2012; we developed a rapid methodology to characterize integrated community case management (iCCM) programs by assessing benchmarks for eight health system components in three program phases. Objective. To assess iCCM benchmarks in Ethiopia three years after scale-up commenced; and to compare the benchmarks across the geographical region. Methods. Six national iCCM experts scored each of 70 benchmarks (no; partial; or yes) and then were facilitated to reach consensus. Results. Overall; iCCM benchmark achievement in Ethiopia was high (87.3); highest for pre-introduction (93.0); followed by introduction (87.9) and scale-up (78.1) phases. Achievement bysystem component was highest for coordination and policy (94.2) and lowest for costing and finance (70.3). Six regional countries' benchmark assessments; including two from Ethiopia 14 months apart; were highly correlated with program duration at scale (correlation coefficient: +0.88). Conclusion. Ethiopia has a mature; broad-based iCCM program. Despite limitations; the method described here rapidly; systematically; and validly characterized a complex program and highlighted areas for attention through government or partners

Effect of the Health Extension Program and other Accessibility Factors on Care-Seeking Behaviors for Common Childhood Illnesses in Rural Ethiopian

Background:In January 2011; Health Extension Workers (HEWs) of Ethiopia's Health Extension Program (HEP) began providing pneumonia case management for children less than five years of age through the integrated Community Case Management (iCCM) strategy. Objective. To report the effect of HEP; following the introduction of iCCM; and other accessibility factors on care-seeking behaviors for common childhood illnesses (acute respiratory infection [ARI]; diarrhea; and fever). Methods. Three possible care-seeking outcomes for childhood illnesses were considered: not seeking appropriate care; seeking care from HEP sources; or seeking care from other appropriate sources. The baseline care-seeking outcomes from the Ethiopian Demographic and Health Survey; 2011; were compared with the care-seeking out-comes in a follow-up iCCM survey in December 2012. The effects of the HEP intensity and other factors on care-seeking outcomes were estimated using regression analyses. Results. Appropriate careseeking for children with acute respiratory infection; ARI; diarrhea; or fever increased two-fold; from 19 at baseline to 38 at follow-up; mainly due to an increase in seeking care for common child-hood illnesses from HEWs. Higher intensity of the HEP and other accessibility factors were associated with higher care-seeking for childhood illnesses from HEP sources. Conclusion. Incorporating iCCM within the HEP service package significantly improved the appropriate care-seeking behaviors for childhoodillnesses in rural Ethiopia

Analysis of Cases of Rape as Seen at the Jos University Teaching Hospital; Jos; North Central Nigeria

Objective: Women are at a higher risk of being sexually harassed. There is a need to document the clinical findings of this crime and its outcome in order to improve the quality of care the victims receive. Materials and Methods: Case notes of patients who presented with alleged rape at Jos University Teaching Hospital between January 2001 and December 2003 were retrieved and analyzed. Results : During the study period; 2;135 patients were seen in the Gynaecological Emergency Unit. A total of 120 were for alleged rape; representing 5.6of the total cases seen. However; only 105 case notes were available for analysis. Of these; 63.8of the alleged rapes were in children; with the infantile age group accounting for 26.7. 36.2of the victims had experienced some form of sexual exposure prior to the rape. A previous relationship with the rapist was established in 77.4of the cases. Most cases delayed in presenting to hospital. Thirty six percent of the cases did not have a human immunodeficiency virus screening test done. Candida albicans (13.3) accounted for most of the infectious agents. Emergency contraception was dministered to the victims when indicated. Conclusion: Women under 16 years of age were at an increased risk of being raped; possibly because they are defenseless and vulnerable. Three quarters (3/4) of the assailants had some form of relationship with the victims; which may account for the delays in reporting. Children and young adolescents were more at risk than adults to be raped

Le kyste hydatique du rein fistulise dans les voies urinaires; prise en charge diagnostique et therapeutique a propos de 14 cas

Objectif l'hydatidose est une pathologie frequente au Maroc et constitue un probleme majeur de sante publique. La localisation renale de cette parasitose est rare. Les formes s'accompagnant de plus d'une fistulisation dans les voies excretrices presentent des particularites diagnostiques et therapeutiques qui seront decrites dans cet article. Patients et methodes 14 patients presentant un kyste hydatique du rein fistulise dans la voie excretrice urinaire ont ete inclus dans l'etude de 2002 a 2008. Les variables etudiees ont ete: l'age moyen; les antecedents; la symptomatologie clinique; l'imagerie; le traitement et l'evolution. Resultats L'age moyen etait de 38 ans (21-54). La douleur lombaire a ete retrouvee chez tous les patients et l'hydaturie chez 8 patients. L'echographie realisee chez tous les patients a montre 6 cas de kyste hydatique de type III et 8 cas de type IV selon la classification de GHARBI. L'uroscanner a confirme la nature hydatique de la masse et deux cas de rein non fonctionnel. L'hydaturie et la dilatation des cavites excretrices ont ete les principaux elements orientant vers le diagnostic. Le traitement a consiste en une resection du dome saillant et la fermeture de la fistule chez 12 patients; huit d'entre eux ont eu une nephrostomie per-operatoire apres cure de la fistule et deux patients une montee de sonde ureterale double crosse en pre-operatoire; les deux autres n'ont pas ete draines. Les deux patients restant ont eu une nephrectomie. Les suites ont ete marquees par une fistule stercorale colique chez un patient et deux cas d'infection de paroi. Conclusion Tout kyste hydatique du rein doit avoir un bilan d'imagerie comportant un uroscanner avec des cliches tardifs a la recherche d'une fistulisation dans la voie excretrice urinaire. Il est conseille de mettre en place une sonde ureterale en preoperatoire a visee diagnostique et therapeutique

Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola

Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical manage-ment reveal weaknesses in obstetric care and may serve as an instrument for future improvement (Afr. J. Reprod. Health 2010; 14[2]:55-62)

Early Onset Pregnancy Induced Hypertension/Eclampsia in Benin City; Nigeria

Pregnancy induced hypertension/eclampsia is a major cause of maternal and perinatal morbidity and mortality in Nigeria. There have been very few studies focussed on early onset pregnancy induced hypertension/eclampsia in Nigerian women To determine the incidence; clinical features and outcome of cases of early onset pregnancy induced hypertension /eclampsia in a Nigerian tertiary hospital; and compare maternofetal outcome in early and late onset disease. : A retrospective study of all cases of early onset pregnancy induced hypertension/eclampsia seen over a five-year period in a tertiary hospital. : Severity of disease; rates of induction of labour; caesarean section rate; maternal mortality; abruptio placenta; still births; severe birth asphyxia and early neonatal deaths. : Early onset pregnancy induced hypertension/eclampsia contributed 6.3of all cases of hypertensive disorders in pregnancy with an incidence of 1:141 deliveries. Most cases presented at between 28-32 weeks gestation (78.3) The disease was severe at presentation or rapidly progressive in 39 cases (84.8) leading to delivery within 72 hours of presentation. Caesarean section was the mode of delivery in 58.7of cases. The perinatal survival rate was 34.0. Early onset pregnancy induced hypertension was associated with significantly higher risk of presenting with eclampsia; having induction of labour and worse perinatal outcome than late onset disease. : Most cases of early onset pregnancy induced hypertension in the study population presented with severe and rapidly progressive disease and were associated with significantly higher risk of obstetric intervention and worse perinatal outcome than late onset disease

Angine aigue: 1ere partie

L'angine encore appelee amygdalite est la survenue d'une douleur de l'oropharynx rendant la deglutition difficile; avec; a l'examen des signes d'inflammation pharynges et amygdalienne. L'agent de sante rencontre frequemment des cas d'angine au cours de sa pratique clinique. Il nous est paru utile de rappeler ici les principales causes de cette affection; comment poser le diagnostique et quels sont les objectifs de sa prise en charge

Prevention and Control of Tuberculosis

Tuberculosis is again becoming a major public health problem. In order to control this complex disease; case-management; chemoprophylaxis and vaccination are used. The aim of case-management is to virtually stop transmission of tuberculosis infection by multidrug chemotherapy. This is; however; hampered by poor drug compliance and the high cost of the most effective drugs. Bacilli-Calmette-Guerin (BCG) vaccination has been used for a long time but with contentious efficacy. Though recent studies put the efficacy at 50; its cost-effectiveness has yet to be established. Isoniazid preventive therapy (1PT) for control of tuberculosis is also rapidly gaining acceptance. In patients who adhere to 80of medication taken; the efficacy is usually high. As for the control of tuberculosis among health care workers; engineering; administrative and personal respiratory measures have been introduced. Following the introduction of these measures in USA; dramatic decline in the risk of tuberculosis among these workers has occurred