Low-fidelity simulation for management of postpartum haemorrhage in a Ghanaian teaching hospital

We conducted a pre/post study of a post-partum hemorrhage (PPH) simulation exercise at Korle Bu Hospital, using a low-fidelity birthing simulator and questionnaires. We aimed to evaluate low-fidelity simulation as a feasible and effective method of improving resident knowledge and confidence in a low-resource setting. Knowledge and confidence in PPH management were measured before and after using 5-point Likert scales and multiple-choice questions. A feedback survey was administered. Descriptive statistics were calculated to summarize demographics, confidence, and knowledge, with frequencies, means and standard deviations reported. Statistical significance of the change in scores was assessed using paired t tests. Statistically significant improvements in knowledge and confidence in managing PPH were evident following the simulation exercise. All participants agreed the simulation was educational, relevant and realistic, and 94% felt it could be incorporated into their training. (Afr J Reprod Health 2022; 26[4]: 57-64)

Building the foundation for universal healthcare: Academic family medicine's ability to train family medicine practitioners to meet the needs of their community across the globe

Background: The Declaration of Astana marked a revived global interest in investing in primary care as a means to achieve universal healthcare. Family medicine clinicians are uniquely trained to provide high-quality, comprehensive primary care throughout the lifespan. Yet little focus has been placed on understanding the needs of family medicine training programs. Aim: This study aims to assess broad patterns of strengths and resource challenges faced by academic programs that train family medicine clinicians. Methods: An anonymous online survey was sent to family medicine faculty using World Organization of Family Doctors (WONCA) listservs. Results: Twenty-nine representatives of academic family medicine programs from around the globe answered the survey. Respondents cited funding for the program and/or individual trainees as one of either their greatest resources or greatest limitations. Frequently available resources included quality and quantity of faculty and reliable clinical training sites. Frequently noted limitations included recruitment capacity and social capital. Over half of respondents reported their program had at some point faced a disruption or gap in its ability to recruit or train, most often because of loss of government recognition. Reflecting on these patterns, respondents expressed strong interest in partnerships focusing on faculty development and research collaboration. Lessons learnt: This study provides a better understanding of the challenges family medicine training programs face and how to contribute to their sustainability and growth, particularly in terms of areas for investment, opportunities for government policy and action and areas of collaboration.

Prevalence and correlates of erectile dysfunction among long-distance commercial vehicle drivers and commercial motorcycle riders in Ibadan Nigeria: a comparative cross-sectional study

Background: Erectile dysfunction (ED) is a global public health problem that affects the quality of life, interpersonal, occupational, and social functioning of sufferers. Despite being high-risk groups, there is a paucity of data on erectile dysfunction among commercial vehicle drivers and motorcycle riders. Objectives: We aimed to determine and compare the prevalence and factors associated with ED among long-distance commercial vehicle drivers (CVDs) and commercial motorcycle riders (CMRs) in Ibadan, Nigeria. Methods: We used a comparative cross-sectional study design to enroll eligible male respondents in selected motor/motorcycle parks within Ibadan metropolis. Interviewer administered questionnaires were used to elicit sociodemographic/health-related characteristics, and ED status among participants. Data was analyzed using STATA version 12. Chi-square and Binary logistic regression were conducted to explore the association between ED and other covariates. Analyses were performed at 5% significance level. Results: The prevalence of ED was significantly higher among motorcycle riders than vehicle drivers (71.4% vs 47.4%, p = 0.001). Predictors of ED among CMRs were monogamous marriage type and history of perineal injury; while among CVRs were aged above 40-years, history of perineal injury, and current use of alcohol. Conclusion: There is a need for public education and awareness programmes on ED to reduce the burden and improve well-being in these populations

Patient satisfaction with intraoral examination in a Nigerian tertiary hospital

Objectives: While studies on satisfaction following medical procedures are well documented, but this is not so with dental procedures. Therefore, this study aims to determine the level of satisfaction in patient undergoing intraoral examination (IOE). Material and Methods: Consecutive patients attending the oral diagnosis clinic of University of Benin Teaching Hospital from April 2020 to September 2020 were interviewed using a questionnaire modified from the modified Group Health Association of America-9 questionnaire. Results: A total number of 103 consecutive dental patients were recruited as they all agreed to participate in the study. The age range was 18­77 years with a mean age of 35.8 ± 14.3 years. There were more males (51.5%). The overall satisfaction was 82.5%. The maximum satisfactory response was on doctor's manner (93.2%), followed by staff 's manner (89.3%), comfort during IOE (80.6%), adequate explanation (78.6%), and finally by waiting time (60.2%). There was association between occupation (P = 0.04) of the patients, type of dental condition (P = 0.03), waiting time (P = 0.01), doctor's manner (P = 0.00), staff manner (P = 0.00), adequate explanation (P = 0.00), comfort during IOE (P = 0.00), and level of satisfaction. The problem rate was 16%. Conclusion: Although waiting time and adequate explanation ranked the highest in terms of unfavorable responses, the overall satisfaction of patients following IOE was generally good. The factors that influence satisfaction were occupation of the patients, type of dental condition, waiting time, doctor's manner, staff manner, adequate explanation, and comfort during IOE.

COVID-19: Cardiovascular care in sub-Saharan Africa during the COVID-19 crisis: lessons from the global experience

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Quels facteurs influencent la qualité de vie des patients tunisiens atteints de cancer du poumon? / Which factors influence the quality of life of Tunisian patients with lung cancer?

Introduction - Les facteurs influençant la qualité de vie (QDV) des patients tunisiens atteints d'un cancer du poumon (CDP) sont méconnus.L'objectif de cette étude est d'identifier les facteurs influençant la QDV des patients tunisiens atteints d'un CDP. Méthodes - Un questionnaire médical a évalué les caractéristiques générales et spécifiques de 100 patients dont 90 hommes, et les questionnaires QLQ-C30 et QLQLC13 ont évalué la QDV. Résultats - Les femmes, les sujets âgés, les mariés et les analphabètes avaient une mauvaise QDV. Comparativement aux patients indemnes de comorbidités, ceux ayant une à deux comorbidités avaient des scores d'activités physiques et professionnelles/loisirs plus bas. Comparativement aux patients ayant un cancer datant de moins d'un an, ceux dont le cancer datait de plus d'un an avaient des scores de santé globale et d'activité physique plus bas, et des scores de nausées/vomissements, d'insomnie et d'anorexie plus élevés. Les patients en stade avancé avaient une mauvaise QDV en termes d'activités physique et émotionnelle, d'insomnie et de constipation. Les patients ayant des métastases avaient une mauvaise QDV en termes de score global, d'activité physique, de fatigue, d'insomnie, d'anorexie et de diarrhée. Le type histologique et le type de traitement n'influençaient pas la QDV. Le sexe n'influençait pas les scores du QLQ-LC13. Comparativement aux patients traités par chimiothérapie, ceux traités par la combinaison chimiothérapie et chirurgie avaient des scores de dyspnée et de neuropathie périphérique plus élevés. Conclusion - Les facteurs suivants influencent la QDV des Tunisiens atteints d'un CDP: le sexe, l'âge, l'état civil, le niveau de scolarisation, les comorbidités, le stade et la durée d'évolution du cancer, et les métastases. Comparativement aux patients traités par chimiothérapie, ceux traités par chimiothérapie et chirurgie avaient des scores de dyspnée et de neuropathie périphérique plus élevés

Introduction - No previous study has established the factors that influence the quality of life (QOL) of tunisian patients with lung cancer (LC).This study aims to identify the factors that influence QOL of tunisian patients with LC. Methods. A medical questionnaire assessed the general and specific characteristics of 100 patients (90 men), and structured questionnaires (QLQ-C30 and QLQ-LC13) assessed QOL. Results -Women, elderly, married and illiterate patients had poor QOL. Compared to patients free from comorbidity, those with one to two comorbidities had lower scores of physical and life-role activities. Compared to patients with cancer discovered less than one year ago, those who's cancer appeared more than one year ago had lower scores of global health, physical activity, nausea/vomiting, and higher scores of insomnia and anorexia. Patients with advanced cancer had poor QOL in terms of physical and emotional activities, and insomnia and constipation items. Patients with metastases had a poor QOL in terms of global health, physical activity, fatigue symptom, insomnia, anorexia, and diarrhea. The histological and treatment types did not influence QOL. The QLQ-LC13 scores were not influenced by sex. However, compared to patients treated with chemotherapy, those treated with chemotherapy and surgery had higher scores of dyspnea and peripheral neuropathy. Conclusion - The following factors influenced QOL of Tunisian patients with LC: sex, age, civil status, schooling level, comorbidities, LC stage and duration, metastases. Compared to patients treated with chemotherapy, those treated with chemotherapy and surgery had higher scores of dyspnea and peripheral neuropathy

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: a needs assessment for improving healthcare resource management

Background:Appropriate referrals of injured patients could improve clinical outcomes and management ofhealthcare resources. To gain insights for system development, we interrogated the current situation by assessingburden, patient demography, causes of injury, trauma mortality and the care-process.Methods:We used an observational, cross-sectional study design and convenience sampling to review patientcharts from 3 major hospitals and the death registry in Tanzania.Results:Injury constitutes 9­13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however,the trauma death registryfigures exceeded the'inpatient deaths'and recorded up to 16%. Most patients arrivethrough a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the traumaadmissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%)were the leading causes of injury. The care process revealed a normal primary-survey rate of 73­90%.Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and dis-ability (80%). Most patients had non-operative management (42­57%) or surgery for wound care or skeletalinjuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were eachperformed in 10%.Conclusion:The burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded inthe death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process,funding and recording. We found a functional hospital referral-network, transport system, and death registry

Injury patterns of patients presenting to a non-governmental hospital in Western Uganda

Introduction: Injury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods: This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results: A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion: Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures

Global health: a lasting partnership in paediatric surgery

Background: To emphasise the value of on-going commitment in Global Health Partnerships. Materials and Methods: A hospital link; by invitation; was set up between United Kingdom and Tanzania since 2002. The project involved annual visits with activities ranging from exchange of skill to training health professionals. Furthermore; the programme attracted teaching and research activities. For continuity; there was electronic communication between visits. Results: Six paediatric surgeons are now fully trained with three further in training in Africa. Paediatric surgery services are now separate from adult services. Seven trainee exchanges have taken place with four awarded fellowships/scholarships. Twenty-three clinical projects have been presented internationally resulting in eight international publications. The programme has attracted other health professionals; especially nursing and engineering. The Tropical Health and Education Trust prize was recently achieved for nursing and radiography. National Health Service has benefited from volunteering staff bringing new cost-effective ideas. A fully funded medical student elective programme has been achieved since 2008. Conclusion: Global Health Partnerships are an excellent initiative in establishing specialist services in countries with limited resources. In the future; this will translate into improved patient care as long as it is sustained and valued by long term commitment

Developing and implementing global gender policy to reduce HIV and AIDS in low- and middle-income countries: policy makers' perspectives

Gender inequalities have been recognised as central to the HIV epidemic for many years. In response; a range of gender policies have been developed in attempts to mitigate the impact and transform gender relations. However; the effects of these policies have been less than successful. In March 2010 the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the Agenda for accelerated country level action on women; girls; gender equality and HIV (the Agenda); an operational plan on how to integrate women; girls and gender equality into the HIV response. This paper explores the perspectives of those involved in developing and implementing the Agenda to understand its strengths and limitations. In-depth one-on-one interviews were conducted with 16 individuals involved in the development and implementation of the Agenda. The data were analysed using thematic network analysis. Facilitators of the Agenda centred on the Agenda's ability to create political space for women and girls within the global HIV/AIDS response and the collaborative process of developing the Agenda. Barriers to the implementation and development of the Agenda include the limited financial and non-financial resources; the top-down nature of the Agenda's development and implementation and a lack of political will from within UNAIDS to implement it. We suggest that the Agenda achieved many goals; but its effect was constrained by a wide range of factors

Disability and poverty ­ reflections on research experiences in Africa and beyond

Background: Whilst broadly agreed in the literature that disability and poverty are closely interlinked, the empirical basis for this knowledge is relatively weak. Objectives: To describe and discuss the current state of knowledge and to suggest the need for further generation of knowledge on disability and poverty. Method: Two recent attempts at statistically analysing the situation for disabled people and a series of qualitative studies on disability and poverty are applied in a discussion on the state of current knowledge. Results: Firstly, the surveys confirm substantial gaps in access to services, and a systematic pattern of lower levels of living amongst individuals with disability as compared to non-disabled. Existing surveys are however not originally set up to study the disability - poverty relationship and thus have some important limitations. Secondly, the qualitative studies have shown the relevance of cultural, political and structural phenomena in relation to poverty and disability, but also the complexity and the contextual character of these forces that may sometimes provide or create opportunities either at the individual or the collective level. Whilst not establishing evidence as such; the qualitative studies contribute to illustrating some of the mechanisms that bring individuals with disability into poverty and keep them there. Conclusions: A longitudinal design including both quantitative and qualitative methods and based on the current conceptual understanding of both disability and poverty is suggested to pursue further knowledge generation on the relationship between disability and poverty

Ischemic Stroke and Neuroprotection

Stroke is a major cause of morbidity and mortality in both developed and developing countries of the world. Greater understanding of the pathophysiology of neuronal damage in ischemic stroke has generated interest in neuroprotection as a management strategy. This paper aims to review the current concept and place of neuroprotection in ischemic stroke. An extensive search of all materials related to the topic was made using library sources including Pubmed and Medline searches. Current research findings were also included. The findings are as presented. Neuroprotection is an increasingly recognized management strategy in ischemic stroke that promises to assist clinicians in reducing stroke mortality rates and improving the quality of life of survivors

Globalization and Health: A Critical Appraisal

Background: Health has long been recognized as a central feature of development. Globalization tends to be understood as a process of economic integration; but it implies more. It entails openness to trade; ideas; investment; people and culture all of which impact health.Method: Review of relevant literature on globalization and health obtained from texts and Pubmed search.Results: Globalization affects health positively and negatively simultaneously; depending on such factors as geographical location; sex; age; ethnic origin; educational level and socioeconomic status. Conclusion: The challenge remains how to make globalization work for health and to use health to foster better forms of globalization. The health community must brace up to the challenge of engaging in the globalization debate with a view to promoting better health for us all

Globalization and Health: A Critical Appraisal

Background: Health has long been recognized as a central feature of development. Globalization tends to be understood as a process of economic integration; but it implies more. It entails openness to trade; ideas; investment; people and culture all of which impact health.Method: Review of relevant literature on globalization and health obtained from texts and Pubmed search.Results: Globalization affects health positively and negatively simultaneously; depending on such factors as geographical location; sex; age; ethnic origin; educational level and socioeconomic status. Conclusion: The challenge remains how to make globalization work for health and to use health to foster better forms of globalization. The health community must brace up to the challenge of engaging in the globalization debate with a view to promoting better health for us all

Implementation of the the global strategy for Health for All by the year 2000 : second evaluation : eighth report on the the world health situation : Vol.2 African Region

This document presents; in Part 1; the regional report drawn up by using the summaries of national reports and data available at the level of technical programmes of the Regional Office. Part 2 carries summaries of contributions sent to WHO by member states. This second evaluation deals with the 1985-1990 period while the first evaluation covered the 1978-1984 period