COVID-19 death: A novel method of improving its identification when a patient has multiple diagnoses

Assigning a primary cause of death to a deceased patient who had multiple principal diagnoses including coronavirus disease 2019 (COVID-19) is challenging because of the difficulty in selecting the most appropriate cause. To proffer a solution, the authors reviewed the literature on assigning a primary cause of death. In 2015, the Nnabuike-Jagidesa (NJ) model II was devised to improve the International Classification of Diseases and related health problems, 10th revision (ICD-10) guideline on how to assign a primary cause of death. The NJ model II stipulates that when there are multiple diagnoses with no plausible explanation that one of the illnesses could have resulted in the other clinical conditions, the single most appropriate primary cause of death is the condition with the highest case fatality ratio in that setting. In the index report, the authors opine that if the case fatality ratios are similar, the following objective criteria (listed in the order of priority) should be used to assign a primary cause of death: condition with the highest infection fatality ratio, condition that was the main indication for the last acute surgical or invasive procedure performed (during the course of the same ill-health) before the death and the disease that theoretically affects the highest number of body organs. Additionally, a clinical descriptor should be used when none of the objective criteria are satisfied. This novel approach, termed the modified NJ model II, is expected to improve the objectivity and reproducibility of the assigned primary cause of death in a deceased who had multiple diagnoses, which may include COVID-19.

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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Atlas des statistiques sanitaires africaines 2022: Analyse de la situation sanitaire de la Région africaine ­ Profils Pays

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Health information systems in Africa: descriptive analysis of data sources, information products and health statistics

Objective To identify key data sources of health information and describe their availability in countries of the World Health Organization (WHO) African Region. Methods An analytical review on the availability and quality of health information data sources in countries; from experience; observations; literature and contributions from countries. Setting Forty-six Member States of the WHO African Region. Participants No participants. Main outcome measures The state of data sources; including censuses; surveys; vital registration and health care facility-based sources. Results In almost all countries of the Region; there is a heavy reliance on household surveys for most indicators; with more than 121 household surveys having been conducted in the Region since 2000. Few countries have civil registration systems that permit adequate and regular tracking of mortality and causes of death. Demographic surveillance sites function in several countries; but the data generated are not integrated into the national health information system because of concerns about representativeness. Health management information systems generate considerable data; but the information is rarely used because of concerns about bias; quality and timeliness. To date; 43 countries in the Region have initiated Integrated Disease Surveillance and Response. Conclusions A multitude of data sources are used to track progress towards health-related goals in the Region; with heavy reliance on household surveys for most indicators. Countries need to develop comprehensive national plans for health information that address the full range of data needs and data sources and that include provision for building national capacities for data generation; analysis; dissemination and use

Comparative Analysis of Global Health Statistics; Implication for Health Education and Promotion

This study examined the differences in health statistics of some selected developing and developed countries. Secondary data were sourced from various international sources such as World Fact book (2008); World Health Organization (2010) and UNICEF(2010). The variables of the study were HIV/ AIDS prevalence and education statistics of Nigeria; Ghana Australia; USA countries formed the dependent. HIV/AIDS is not significant as a predictor of life expectancy in these countries as HIV/ AIDS statistics of the five countries contributed 5.4to life expectancy (R=0.548). However it is a predictor of life expectancy in Ghana and Nigeria; with a t-value of 2.975 and -3.090 respectively. Both were significant at 0.05 alpha levels. The t-value of all five countries shows that none was significant in the use of education as a predictor of life expectancy. It was recommended that Nigerian government should to raise health expenditure to the agreed 15of the budget and make more effort at increasing school enrollment at the primary and secondary levels. This must be followed with employment opportunities to raise the living standard of the people. This comprehensive approach to health status will increase life expectancy among Nigeria

The Phelophepa Health Care Train: a Pharmacoepidemiological Overview of the Western Cape in 2009

Background: The Phelophepa Health Care Train is the only primary healthcare train in the world. Phelophepa is an innovative initiative that attempts to make a positive difference to primary healthcare in rural South Africa. The primary aim of this study was to determine the epidemiological and prescribing statistics for Phelophepa during the period that the train was stationed in the Western Cape in 2009. Methods: Phelophepa visited seven stations during the eight weeks that it was stationed in the Western Cape (between 6 April and 5 June 2009). Data were collected by workers and students on the train. Results: A total of 4 026 prescriptions were dispensed by the pharmacy on Phelophepa during the eight weeks. The average number of items per prescription was 3.51. The average cost per prescription was R65;48 (average cost of R18;64 per item). Patients only paid R5;00 per prescription. There was an increase in the number of pulmonary diseases/infections as well as ophthalmic conditions (especially dry eyes). Common problems experienced during the outreach to schools were ear infections and chest infections. Common conditions identified in Caledon; for example; were musculoskeletal problems; genitourinary conditions; fungal infections and eye disorders. Medication is prescribed mainly by nurses and includes those listed in the Primary Healthcare Essential Drug List. Conclusions: The statistics compiled by Phelophepa are a useful source of pharmacoepidemiological data about rural South Africa. It is recommended that more studies be conducted to detect especially epidemiological differences between regions visited; as well as changes over time

Profile of Research Methodology and Statistics Training of Undergraduate Medical Students at South African Universities

Background: Medical practitioners need to have knowledge of statistics and research principles; especially with the increasing emphasis on evidence-based medicine. The aim of this study was to determine the profile of research methodology and statistics training of undergraduate medical students at South African universities in terms of which topics are taught; by whom teaching is done; when these topics are taught and how they are taught. Method: Respondents for this descriptive study were persons responsible for the teaching of statistics and research methodology at the eight medical schools in South Africa. They were identified by the head of each school who also gave permission for the school to participate. The respondents completed a questionnaire and checklist after giving informed consent. No response was obtained from one university. Responses were compared to international guidelines. Results: At five universities the material is taught in the first year; at one in the second year and one in the third or fourth year; depending on when it is selected as an elective. The material is reinforced in other modules in the medical programme at three universities. The persons responsible for teaching are mainly statisticians (six universities). Class sizes vary from 40 to 320 students with four universities having 200 or more students per class. At two universities the current course has been in place since 2003; at two since 2000; and at two since the 1970/80s. The following topics are taught at the majority of universities: study designs in medical research; exploring and presenting data; summarising data; probability; sampling; statistical inference; analysis of cross tabulation and critical reading. At four universities there are practical classes; three of these mainly for computer work. At three universities tutors are used; at two of these the tutors are postgraduate students in statistics whereas at one university registrars; doctors and researchers are used as tutors. Students at three of the universities complete a research project; at two of these the students complete the full research process from planning up to reporting; whereas the project at the other university focuses mainly on the analysis of data. Conclusion: Recommendations have been made regarding topics which should be covered and teaching methods which should be used at all universities. Doctors should be involved in the training to ensure clinically appropriate material and examples

A Review of Outcome of Postgraduate Medical Training in Zambia

The University of Zambia School of Medicine was opened in 1966. Since inception; over 1200 undergraduate students have graduated with Bachelor of Medicine and Bachelor of Surgery. The postgraduate Master of Medicine (M.Med)programme was started in 19822 with the intention of providing district specialists in the rural and semi urban communities of Zambia. Additional hope was to stem the brain drain to other countries. This is a study to describe the deployment of graduates of the M.Med training programs at the University of Zambia School Of Medicine in relation to the objectives defined by the University of Zambia senate in 1981. It was found that the School of Medicine has produced 118 Master of Medicine graduates in 5 clinical programs over a period of 22 years. The average graduation rate is 5 students per annum. The largest specialist group has been in General surgery with 34 (29) of all graduates. The ratio of men to women was 3 to 1. The ratio of Zambian to Non Zambian ratio was 10:1. Of all students who have graduated over this period 13 (11) have gone abroad and 7(6) have died.; Eighty-eight (75) of the graduates are working along the line of rail in the 5 most urbanized towns in the country. Twenty-five ( 21) are doing non clinical jobs which involve health programs administration and 12 (10) are working in private practice. We concluded that external migration is not a major problem and; overall; the creation of a local postgraduate training program has reduced brain drain. The key challenge is internal brain drain

Using VCT Statistics from Kenya in Understanding the Association between Gender and HIV

This paper demonstrates the importance of utilising official statistics from the voluntary counselling and testing centres (VCT) to determine the association between gender and HIV infection rates in Kenya.The study design adopted was a record based survey of data collected from VCT sites in Kenya between the second quarter of 2001 and the second quarter of 2004. Of those who were tested; significantly more females tested positive (P0.0001) and had twice as high a chance of being infected by HIV (Odds ratio 2.27 with CI 2.23 to 2.31) than males.We conclude that VCT statistics may lead to better planning of services and gender sensitive interventions if utilised well

Morbidity profile of admissions to GF Jooste Hospital; Manenberg; Cape Town

BackgroundSecondary hospitals play an important; yet overlooked; role in reflecting public health status; both locally and nationally. Relatively few reports analysing the causes of secondary hospital admissions exist; which is especially unfortunate in the case of developing countries; considering the huge numbers of admissions and people at risk. In developing countries like South Africa; the quality of records varies among institutions. Some hospitals have computerised data; while others may keep no records whatsoever. A major problem facing the quality of hospital records is the constant shortage of staff in rural and urban hospitals. Thorough documentation is essential in providing an invaluable database for researchers; but morbidity statistics are unfortunately scarce.GF Jooste Hospital in Manenberg is the busiest hospital in Cape Town - serving 1.1 million people; with 224 beds and over 12 000 admissions annually. Budgetary constraints in the South African public health sector means that providing healthcare services at higher levels than necessary is too costly. Because hospitals consume the largest share of the public healthcare budget; they have been the focus in cost cutting. In particular; the budgets of referral (tertiary or teaching) hospitals have been trimmed in order to promote primary and secondary care. It is imperative to identify those services that are required most at secondary hospitals in order to improve budgeting and; more appropriately; train doctors and medical students for the job at hand. Identifying the morbidity profile of the population for which the hospital caters can aid the optimal utilisation of the available resources; as well as focusing the continuing medical education of hospital physicians. We determined disease patterns of admissions over a three-year period (2001-2003); primarily as insight towards optimal hospital resource management.MethodsA retrospective study examined ward records; totalling 36 657 admissions; from which a random sample (N=608) was selected. A stratified sample (N=462) was constructed; considering the relative proportions admitted to the wards. The International Statistical Classification of Diseases (ICD) directed diagnosis sorting. Disease prevalence was expressed as the percentage of patients allocated to each ICD category among those admitted to the hospital and respective wards and; additionally; the percentage of diagnoses for each ICD subcategory among patients assigned to each major category.ResultsTrauma (represented by ICD categories S/T 23and V/X/Y 16); specifically assault-related; was most prevalent. This was followed by circulatory diseases (22) and infectious diseases (19); dominated by HIV (61) and associated diseases like TB (57). The age of the patients ranged from 13 to 87 (mean: 40 years); with the 20 to 30-year-olds predominating. Surgical patients were younger (mean: 35 years) than medical (mean: 45 years). In the medical wards; infectious (39in men; 38in women) and circulatory aetiologies (39and 41in men and women respectively) dominated. In the surgical wards; the trend varied according to sex: assault (43) and other injuries (61) for males; pregnancy-related (42) for females. ConclusionThe morbidity distribution reflects the ills affecting South African urban society; with young trauma admissions predominating. The hospital's budget is insufficient; considering its population's demands

Controle de qualite post-marketing de medicaments uu Burkina Faso : des resultats satisfaisants

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A National Health Plan for South Africa

The health of all South Africans will be secured mainly through the achievements of equitable social and economic development. The legacy of apartheid policies in South Africa has created large disparities between racial groups in terms of socio-economic status; occupation; housing and health. This document focuses on the health system; but it links with the reconstruction and development programme which involves all other sectors. Health will therefore be viewed from a development perspective; as an integral part of the socio-economic development plan of South Africa