Rectal artesunate for severe malaria, implementation research, Zambia

Objective To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. Methods In partnership with government, in 10 rural districts during 2018­2021 we: (i) trained community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) supported communities to establish emergency transport, food banks and emergency savings to reduce referral delays; (iii) ensured adequate drug supplies; (iv) trained health workers to treat severe malaria with injectable artesunate; and (v) monitored severe malaria cases and associated deaths via surveys, health facility data and a community monitoring system. Results Intervention communities accessed quality-assured rectal artesunate from trained community health volunteers, and follow-on treatment for severe malaria from health workers. Based on formal data from the health management information system, reported deaths from severe malaria reduced significantly from 3.1% (22/699; 95% confidence interval, CI: 2.0­4.2) to 0.5% (2/365; 95% CI: 0.0­1.1) in two demonstration districts, and from 6.2% (14/225; 95% CI: 3.6­8.8) to 0.6% (2/321; 95% CI: 0.0­1.3) in eight scale-up districts. Conclusion Despite the effects of the coronavirus disease, our results confirmed that pre-referral rectal artesunate administered by community health volunteers can be an effective intervention for severe malaria among young children. Our results strengthen the case for wider expansion of the pre-referral treatment in Zambia and elsewhere when combined with supporting interventions.

Oral health seeking behaviour among patients attending outpatient clinic in University of Ilorin teaching hospital (UITH) Ilorin

Introduction: In sub ­ Saharan Africa, oral health services are greatly hampered by low availability and poor accessibility to health care and these are various interrelated factors responsible. This study determined the factors that influence oral health seeking behavior among patients attending outpatients' clinic. Methodology: A total of 460patients were selected into the study from the outpatients' clinic using systematic random sampling. Data was collected and was analyzed using SPSS 17. The significant level was set at 0.05 Results: Of the 97.3% of the respondents with awareness of oral health facility, 90.9% of them had oral health facility within 5km distance. The commonest complaint was toothache. Majority of the respondents (88.2%) accessed orthodox oral health services mostly for teeth extraction (61.3%). There was statistically significant difference between the awareness of Oral health facility and closeness to residence. Conclusion: Age, awareness and attitude have positive effect on health seeking behavior of patients.

The covid-19 pandemic: research and health development in the World Health Organisation Africa region

Concerns have been expressed about the view point of WHO AFRO concerning research for health in the African Region. WHO AFRO considers research a critical component in the improvement of health in the Africa region. Ensuring the effectiveness of our strategies, policies and programmes requires evidence. In the context of the ongoing COVID-19 outbreak, WHO research interests cover key areas of the response. The WHO AFRO consider research as critical in our efforts at protecting people against health emergencies and pandemics like the COVID-19 and ensuring universal access to proven interventions. In view of this, the WHO has taken steps to strengthen capacity for research in the region. The results of these efforts may take time to manifest but will surely do as we persist in our drive, with support from our partners

Evaluating the performance of South African primary care: a cross-sectional descriptive survey

Introduction: In 2018 governments reaffirmed their commitment to implementing primary health care (PHC) in the Astana Declaration. South Africa has introduced a number of health reforms to strengthen PHC and enable universal health coverage (UHC). UHC requires access to quality primary care and progress needs to be measured. This study aimed to evaluate the quality of South African primary care using the Primary Care Assessment Tool (PCAT).Methods: A descriptive cross-sectional survey used data derived from a previous analytical observational study. Data from 413 patients, 136 health workers and 55 managers were analysed from 30 community health centres across four provinces of South Africa. Scores were obtained for 10 key domains and an overall primary care score. Scores were compared in terms of respondents, provinces and monthly headcount.Results: Patients rated first contact accessibility, ongoing care and community orientation as the poorest performing elements (< 50% scoring as 'acceptable to good'); first contact utilisation, informational coordination and family-centredness as weaker elements (< 66% scoring as 'acceptable to good'); and comprehensiveness, coordination, cultural competency and availability of the PHC team as stronger aspects of primary care (≥ 66% or more scoring as 'acceptable or good'). Managers and providers were generally much more positive about the performance of PHC.Conclusion: Gaps existbetweenPHCusers' experience of care andwhat PHCstaffbelieve they provide. Priorities to strengthen South African primary care include improving access, informational and relational continuity of care, and ensuring the implementation of community-orientated primary care. The PCAT is a useful tool to measure quality of primary care and progress with UHC

Bibliometric trends of South African environmental health articles between 1998 and 2015: Making local research visible and retrievable

Background. South Africa (SA) has to grapple with multiple burdens of disease for which environmental factors have a role to play in both causation and prevention. This article describes a bibliometric review of environmental health indexed literature for SA over an 18-year period.Objectives. To provide an overview of the nature of SA-based published environmental health indexed research and to identify search challenges, frequently researched topics, and gaps and opportunities for future research.Methods. The Web of Science, PubMed and Science Direct were used to search for original, peer-reviewed and review articles with the inclusion criteria 'environmental health' and 'South Africa' available online and published between 1998 and 2015, inclusively.Results. A total of 230 journal articles were included in the bibliometric analysis. The highest number of articles (n=54) was published in 2015. The majority of the first authors were affiliated with SA institutions (n=160, 69.5%). For the articles where funding was explicitly declared (n=148), the three most frequently occurring agencies that funded the published research were the National Research Foundation in SA (n=17), the South African Medical Research Council (n=13) and the Water Research Commission (n=9). There was little inter-annual/environmental health category variation over time owing to the relatively small sample size. The largest number of retrieved journal articles was in the area of environmental pollution control (n=76), followed by environmental health lifestyle and behaviour-related topics (n=42) and then water monitoring (n=26).Conclusions. Despite the research needed to solve large environmental health challenges in SA, environmental health was only used as a keyword in title, author keywords or abstract for 230 SA-based studies over an 18-year period. This makes it extremely difficult for environmental health research to be located and used to inform the profession as well as the research agenda. Several issues that environmental health practitioners are typically tasked to implement and monitor are not indexed as environmental health topics. The need for authors to use 'environmental health' as a keyword is emphasised, particularly if research is to inform decision-making and policy support, as well as guide future research in the country

Boni Mores and Consent for Child Research in South Africa

Consent is required for almost all health research. In order for consent to be valid a number of requirements must be met including that the consent cannot be contra bonos mores or contrary to public policy. This principle has its roots in the common law and it is used to ensure that the consent to harm; or the risk of harm; is permitted or ought to be permitted by the legal order. Recently; it has also become a statutory requirement embedded in the consent obligations relating to non-therapeutic health research with minors. Section 71 of the National Health Act provides that the Minister of Health (or potentially his or her delegated authority) must provide consent to non-therapeutic research with minors. However; such consent may not be granted if 'the reasons for the consent to the research or experimentation are contrary to public policy'. Limited work has been done on how to determine when consent to health research with children would be contrary to public policy. This article attempts to begin the debate by describing the boni mores principle; setting out some of the general factors that could be used to assess whether consent is consistent with it and suggesting how they could be applied to health research.The article concludes by stating that simply requiring proxy consent for non-therapeutic health research with children is insufficient as it cannot always be assumed that proxy consenters will act in the best interests of the child. Thus the boni mores principle acts as a limit on autonomy in order to protect the child participant. It is further submitted that establishing when consent to health research is consistent with public policy requires an assessment of whether the research is consistent with constitutional values; prevailing legal norms regarding children; and an assessment of the legal convictions of the community

Ethical Guidelines for Military-Based Health Research: an Unmet Need in Africa?

"Background: Achieving the highest standards of ethics in military health research is a challenging but crucial undertaking. The military environment is complex and African military health professionals struggle to maintain a balance between ethics and military ethos. The objective of this paper is to review ten existing research ethics guidelines for their application to the military context; and describe the need for guidance in military research ethics in sub-Saharan Africa.Method: To achieve this; five prominent international research ethics guidelines and five African guidelines were selected using some inclusion/exclusion criteria. Thereafter; designed topics were used in analyzing them for their strengths and weaknesses in providing protection for military research participants.Results: Out of the five international guidelines reviewed; only the Council for International Organization of Medical Sciences (CIOMS) mentions the ""armed forces"". Similarly; the only African national guideline that specifically mentions the ""armed forces"" is the Ugandan national guideline.Conclusions: We conclude that national and international guidelines for human subject research may be too general and not suitable for research with military populations. There is a need for additional guidance in research ethics for militaries in sub-Saharan Africa."

Review Paper on Research Ethics In Ethiopia: Experiences and Lessons Learnt from Addis Ababa University College of Health Sciences 2007-2012

Health research in Ethiopia is increasing both in volume and type; accompanied with expansion of higher education and research since the past few years. This calls for a proportional competence in the governance of medical research ethics in Ethiopia in the respective research and higher learning institutes. The paper highlights the evolution and progress of the ethics review at Addis Ababa University- College of Health Sciences (AAU-CHS) in the given context of health research review system in Ethiopia. Reflections are made on the key lessons to be drawn from the formative experiences of the Institutional Review Board (IRB) and their implications to the Ethiopian health research review system. This article is a review paper based on review of published and un published documents on research ethics in Ethiopia and the AAU-CHS (2007-2012). Thematic summaries of review findings are presented in thematic areas - formation of ethics review and key factors in the evolution of ethics review and implications The IRB at AAU-CHS has been pivotal in providing review and follow-up for important clinical studies in Ethiopia. It has been one of the first IRBs to get WHO/SIDCER recognition from Africa and Ethiopia. Important factors in the successes of the IRB among others included leadership commitment; its placement in institutional structure; and continued capacity building. Financial challenges and sustainability issues need to be addressed for the sustained gains registered so far. Similar factors are considered important for the new and younger IRBs within the emergent Universities and research centers in the country

Surveying the knowledge landscape in Sub-Saharan Africa: Methodology

Objective To describe in detail the methods followed in each of the qualitative and quantitative surveys of national health information; research and knowledge systems and research institutions. Design Cross-sectional surveys. Setting National health information and research systems; and 847 health research institutions in 42 countries in the World Health Organization (WHO) African Region. Participants Key informants from health research institutions; ministries of health and statistical offices. Main outcome measures Stewardship; financing; ethics; human and material resources and output of health information and research systems. Results Key informants were used to collect data to assess national research systems in 44 countries in the Region. The same method was followed in assessing national information systems in 17 countries and knowledge systems for health in 44 countries. These assessments included a detailed review of the state of data sources in the Region and their effect on measuring progress on the health-related Millennium Development Goals. A concurrent survey employed a structured questionnaire (the WHO Health Research Systems Analysis Questionnaire) to assess the capacity of 847 health research institutions in 42 countries. Stewardship; financing; ethics; human and material resources and research output were assessed. Conclusions The logistics and resources involved in surveying the knowledge landscape in the 42 countries were substantial. However; the investment was worthwhile as the results of the surveys can be used to inform policy-making and decision-making; as well as to establish a regional database of national health information; research and knowledge systems

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey

Objective To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). Design A structured questionnaire was used to solicit financial information from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Main outcome measures Expenditure on health research by institutions; funders and subject areas. Results An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding; ministries of health; other government ministries; own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research; with medical schools spending 82 and government agencies 62. Hospitals spent 38 of their resources on management; and other institutions (universities; firms; etc.) spent 87 of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30 of funds; followed by research on other communicable diseases and maternal; perinatal and nutritional conditions (23). Conclusions Research on major health problems of the Region; such as communicable diseases; accounts for most of the research expenditures. However; the total expenditure is very low compared with other WHO regions

Research output of health research institutions and its use in 42 Sub-Saharan African countries: results of a questionnaire-based survey

OBJECTIVE:To describe and analyse research output from surveyed national health research institutions in Africa.DESIGN: The survey used a structured questionnaire to solicit information from 847 health research institutions in 42 countries of the World Health Organization African Region.SETTING:Eight hundred and forty-seven health research institutions in 42 sub-Saharan African countries.PARTICIPANTS: Key informants from the health research institutions.MAIN OUTCOME MEASURES: Volume, type and medium of publications, and distribution of research outputs.RESULTS:Books or chapters for books accounted for the highest number of information products published (on average 16.7 per respondent institution), followed by patents registered in country (8.2), discussion or working papers (6.5) and conference proceedings (6.4). Publication in a peer-reviewed journal constituted only a minor part of research output (on average about 1 paper per institution). Radio and TV broadcasts on health research accounted for the highest number of products issued by institution staff (on average 5.5 per institution), followed by peer-reviewed journals indexed internationally (3.8) or nationally (3.1). There were, on average, 1.5 press releases, 1.5 newspaper or magazine articles, and 1.4 policy briefs per institution. Over half of respondent institutions (52%) developed briefs and summaries of articles to share with their target audiences, 43% developed briefs for possible actions and 37% provided articles and reports upon request. Only a small proportion of information products produced were available in institutional databases.CONCLUSIONS:The research output of health research institutions in the Region is significant, but more effort is needed to strengthen research capacity, including human and financial resources

Human resources in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey

Objective To describe the current status of institutional facilities and the supporting research infrastructure of surveyed health research institutions in Africa; including information on communication technologies and connectivity; library resources; and laboratory operations and resources. Design A structured questionnaire was used to solicit information on institutional facilities at health research institutions. Setting Health research institutions in 42 sub-Saharan African countries. Participants Key informants from 847 health research institutions. Main outcome measures The availability of laboratory; information and communication; and library facilities in health research institutions. Results Less than half of the respondent health research institutions had computer laboratories (49); network computers (50) and information technology support (38). More than two-thirds (67) had a library. Electronic subscriptions to international journals were observed to be very low; with an average of three subscriptions per institution. Almost two-thirds of the surveyed institutions (69) reported having laboratories; about half of which (55) were accredited nationally. Linkages and research collaborations were generally weak; particularly those with other laboratories in the Region. Challenges included financial and human resource constraints and the inability to communicate effectively with partners. Conclusions Health research institutions in the Region have insufficient access to essential facilities such as laboratories; libraries; computers and the Internet to generate; access and share information

Research and its governance in health research institutions in Sub-Saharan African countries: results of a questionnaire-based survey

Objective:To describe governance and stewardship of research in health research institutions in the World Health Organization (WHO) African Region. Design: A structured questionnaire was used to solicit information on governance and stewardship from health research institutions. Setting: Forty-two Member States of the WHO African Region. Participants: Key informants from the respondent health research institutions in the respondent sub-Saharan African countries. Main outcome measures: Institutions' participation in setting the national health research agenda. Institutional research priorities; scientific reviews and governance structure. Results: During the previous 12 months; the heads of 49 of respondent health research institutions participated in the setting or coordination of national research priorities. The most frequently cited priorities for contributing to or performing research were improving health programmes; producing new knowledge; influencing health policies and conducting operational research. For 78 of respondent institutions; scientific review was required for research funded directly by the institution; and for 73 of respondent institutions; scientific review was required for research not funded by the institution. However; most respondent institutions did not have written policies or guidelines; either for the scientific review of proposals (70) or regarding conflict of interest on scientific review committees (80). Conclusions: Some health research institutions demonstrate good practice in terms of the establishment of structures and processes for governance and stewardship; many others do not. There is a need for the strengthening of the stewardship capacity of research institutions in the Region

PURE ifying Research on Chronic Non-Communicable Diseases in South Africa

Chronic non-communicable diseases (NCDs) such as diabetes; cardiovascular disease (CVD) and cancers are a major public health problem. In an effort to increase awareness about the behavioural risk factors for NCDs a community-based project was implemented in Khayelitsha. Informed by the results of this study the School of Public Health at the University of the Western Cape joined the Prospective Urban and Rural Epidemiology (PURE) study in January 2009. The study seeks to scientifically document the root-causes of the traditional risk factors for NCDs by following-up adults aged 30 to 75 years for 12 to 15 years and collecting individual-; household-; community- and national-level information. Responding effectively to the growing burden of NCDs incorporates addressing societal and biological pathways from environmental causes to primordial predispositions and adequately managing the primary risk factors

Perceptions of Central Gauteng Occupational Health Nursing Practitioners of their Traditional and Expanded Roles

This paper provides an overview of the fi ndings of a cross-sectional survey conducted in 2011 that investigated the perceptions of Central Gauteng occupational health nursing practitioners of their traditional and expanded roles and role activities; using a self-administered questionnaire. In the traditional role area; high importance was given to the functions of health assessment and providing direct care of job-related emergency and minor illness episodes. The assistance of rehabilitation and relocation of disabled workers was rated low in overall importance. In the expanded role area; the highest importance was given to managing an occupational health service; while the lowest importance was given to research-related activities. The results demonstrate that occupational health nursing practitioners need to engage in research activities and conduct situational analyses of workplaces

Profile and outcome of medical emergencies in a tertiary health institution in Port Harcourt, Nigeria

Medical emergencies are a daily occurrence in medical practice. The profile and outcome medical emergencies are a reflection of the prevailing pattern of disease and the responsiveness of the healthcare system. This study seeks to evaluate the pattern and outcome of medical emergencies presenting to the university of Port Harcourt teaching hospital (UPTH); Port Harcourt.METHODS: A retrospective study of medical records of the accident and emergency unit of UPTH was assessed over a twelve month period (June 2008 May 2009).RESULTS: A total of 7246 patients presented to the emergency room; with 1256 (17.3) medical emergencies. Infectious diseases accounted for 274 (21.8) of emergencies while non-communicable diseases in the cardiovascular 195 (15.5); renal 105 (8.4); neurological 224 (17.8); endocrine 163(13.0) and gastrointestinal/ hepatobiliary 163(13.0) systems were the other prevalent emergencies. The crude mortality rate was 127 deaths (10.2). The major contributors to mortality were HIV/AIDS related infectious diseases (22.4); hypertension related heart disease (18.4) and stroke (15.7). Other contributors to mortality were renal failure (8.8); diabetic emergencies (8.8); chronic liver disease (12.8) and haematological malignancies (9.6).CONCLUSION: The spectrum of medical emergencies and the pattern of mortality indicate a mixed disease burden of infective and non-communicable diseases; with cardiovascular and cerebrovascular diseases and HIV/AIDS related infectious as the most significant contributors. There is need for action to improve on the responsiveness of our healthcare systems to cope with this trend of disease pattern in our emergency rooms and reduce mortality from medical emergencies

'Every Teacher is a Researcher!': Creating Indigenous Epistemologies and Practices for HIV Prevention through Values-Based Action Research

Since gender is an undisputed driver of HIV infection; teachers concerned with HIV prevention education should ideally encourage critical awareness of and culturally sensitive practices around gender inequalities. Many interventions and programmes have been developed for teachers to enable them to do this; however most have met with limited success. This article proceeds from the viewpoint that for HIV-prevention interventions to be sustainable and effective; teachers should be actively engaged in their design; implementation and evaluation. It outlines how teachers in an HIV prevention programme utilised an action research design to explore their own gender constructs as a necessary first step to the creation of more gender-sensitive school climates and teaching practices. This values-based self-enquiry moved the teachers to action on two levels: first; to adopt a more gendersensitive approach in their own personal and professional lives and second; to take action to challenge gender inequalities within their particular educational contexts. Evidence is presented to justify the claim that action research of this genre helps teachers to generate indigenous epistemologies and practices that not only are effective in creating sustainable and empowering learning environments for HIV prevention education; but also for teaching and learning in general

'Checkmating HIVetAIDS': Using Chess to Break the Silence in the Classroom

In this article; I give an account of my 'Checkmating HIVetAIDS' action research project; which was an attempt to break the 'culture of silence' concerning HIVetAIDS and sex and sexuality in my classroom. In this project; I focused specifically on one code of sport; namely chess; and I point out and discuss the potential of using chess as an educational tool in addressing HIVetAIDS. It was found that learners enjoy playing chess and that it can be used in the Life Orientation classroom to promote HIVetAIDS awareness. This type of alternative awareness is relevant as learners in most schools were becoming fatigued by HIVetAIDS information overload. The project portrays the role of the teacher as a researcher and critical change agent in an HIVetAIDS-challenged society

Perceptions of Nigerian Medical Specialists on Research

"The current research aimed at collating the views of medical specialists on disease priorities; class and outcomes of health research in Nigeria; and draw appropriate policy implications. Structured questionnaires were distributed to consent 90 randomly selected medical specialists practising in six Nigerian tertiary health institutions. Participants' background information; relative disease priority; research types and class; type and class of publication media; frequency of publications; challenges faced in publishing research; impact of their research on health practice or policy; and inventions made were probed. Fifty-one out of the 90 questionnaires distributed were returned giving a response rate of 63.3. Sixty-four point six percent indicated that the highest priority should be given to non communicable diseases while still recognizing that considerations should be giving to the others. They were largely ""always"" involved in simple low budget retrospective studies or cross-sectional and medical education studies (67.8) and over a third (37.5) had never been involved in clinical trials. They largely preferred to ""always"" publish in PubMed indexed journals that are foreign-based (65.0). They also indicated that their research works very rarely resulted in inventions (4) and change (4) in clinical practice or health policy. Our study respondents indicated that they were largely involved in simple low budget research works that rarely had significant impacts and outcomes. We recommend that adequate resources and research infrastructures particularly funding be made available to medical specialists in Nigeria. Both undergraduate and postgraduate medical education in Nigeria should emphasize research training in their curricula."

The Role of Community Advisory Boards in Health Research: Divergent Views in the South African Experience

In the light of the growing involvement of community advisory boards (CABs) in health research; this study presents empirical findings of the functions and operations of CABs in HIV/AIDS vaccine trials in South Africa. The individual and focus group interviews with CAB members; principal investigators; research staff; community educators; recruiters; ethics committee members; trial participants and South African AIDS Vaccine Initiative (SAAVI) staff members demonstrated differences in the respondents' perceptions of the roles and responsibilities of CABs. These findings question the roles of the CABs. Are they primarily there to serve and be accountable to the community; or to serve the accomplishment of the research objectives? Four emergent themes are discussed here: purpose; membership and representation; power and authority; sources of support and independence. The CABs' primary purpose carries significant implications for a wide range of issues regarding their functioning. The dual functions of advancing the research and protecting the community appear to be fraught with tension; and require careful reconsideration