Guidelines for the use of transient elastography in South Africa

Liver fibrosis assessment is key to rapid decision making with respect to treatment and prognosis in liverdisease Liver biopsy remains the gold standard for assessing fibrosis and pattern of injury but is invasive, costly, relatively unavailable and is unsuited to the rapid and efficient upscaling of treatment to those in need of care e.g. viral hepatitis Non invasive technologies are supplanting liver biopsy as the primary means of assessing liver fibrosis Transient elastography (FibroScan® ) ­ first introduced in 2003 ­ has evolved as a reliable and validated noninvasive technology for assessing liver fibrosis The technique is simple and requires easily transferrable operator skills A minimum of 10 readings are required to be valid Substantial data supports its validity in a variety of chronic liver diseases with AUROC scores that range between 0.85 and 0.95 FibroScan® has the added benefit of assessing fatty change in the liver via the CAP (Controlled Attenuation Parameter) assessment score Potential users of this technology should acquire the requisite upskilling to operate Transient Elastography (FibroScan® ) To achieve the objectives of the National Viral Hepatitis Elimination Strategy in South Africa, such technology will be needed in the public sector The cost effectiveness of this technology with appropriate allocation of funding codes is required for the private sector

Guidelines for the use of transient elastography in South Africa

The World Health Organization (WHO) published a report in 2016 towards combating hepatitis B and C to reach elimination by 2030. Viral hepatitis is a leading cause of death worldwide and in 2013, 1.46 million deaths were attributed to this disease ­ more than 90% due to complications of hepatitis B and C. Shockingly, less than 0.3 % of patients with HBV infection gets diagnosed in the WHO African region. This combined with the fact that fewer than 1% receives treatment, greatly contributes to the spread of the disease

Prevalence and pattern of parasitic infestations among nomadic Fulani children in a grazing reserve in Northwestern Nigeria

Background: Nomadic pastoralists lack access to basic sanitary and health-care facilities mainly because their mode of life makes them a hard to reach group. In the Nigerian context, there is dearth of knowledge about the interplay between their lifestyle and health indices.Therefore, this study is aimed at determining the association between the prevalence of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Aim: The aim of this study was to assess the prevalence and pattern of parasitic infestation among nomadic Fulani children in Ladduga grazing reserve, Kaduna, Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study was conducted using questionnaires, physical examination, automated hemocytometry, enzyme-linked immunosorbent assay-based serum ferritin assay, and formol-ether concentration-based stool tests on 337 children (5­15 years) at Ladduga grazing reserve, Northwestern Nigeria. Data were analyzed using SPSS version 20.0. Results: The prevalence of parasitic infestation was 14.4% (49/337). The predominant parasites found were hookworm species, i.e., Necator americanus and Ancylostoma duodenale (46.9%) and Schistosoma mansoni (26.6%) while Ascaris lumbricoides, Hymenolepis nana, and Enterobius vermicularis accounted for 26.6%. Anemia was found in 40.4% (137/340) of the children with a statistically significant difference between younger (5­9 years) and older children (10­15 years; P < 0.05). Of those with parasites in the stools, 53% of children had anemia. Iron deficiency anemia was found in only 8.1% (4/49) of children. Conclusion: The prevalence of anemia was high in the studied population, but iron deficiency was not a major cause despite hookworm infestation, thus necessitating the need for further studies to identify other causes of anemia among this group

HIV/AIDS among pastoralists and refugees in Kenya: a neglected Problem

The eight member states (Djibouti; Eritrea; Ethiopia; Kenya; Somalia; South Sudan; Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention; care and treatment programmes since the late 1980s; the IGAD Regional HIV et AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour; vulnerability; HIV prevalence and interventions; under the headings pastoralists; refugees; IGAD and north-east Africa for the period 2001-2014. Of the 214 documents reviewed; 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia; Kenya; Somalia and Uganda and from 1% to 5% among refugees in Sudan; Kenya and Uganda. Socioeconomic; cultural; logistic; infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore; interventions must extend beyond the health sector and improve the livelihood of these populations

Oscillating Migration Driving HIV and TB in Sub-Saharan Africa

The system of oscillating labour migration; especially to the gold mines in South Africa; has helped to spread TB throughout southern Africa and it now helps to spread HIV. This article illustrates this link by reporting on a study on the impact of migrant labour in the mines in South Africa on the burden of HIV and TB in Mozambique. Furthermore; modelling studies have shown that even if we maintain the same patterns of sexual behaviour the presence or absence of migration can lead to dramatically different outcomes. Unless a comprehensive and fully coordinated multi-country and multi-sectoral programme is implemented and followed through; we may find that the HIV and TB epidemics are far more resilient than consideration of the epidemics in each country suggests

Sexual risk behaviours and HIV knowledge of migrant farm workers in a rural community in Nigeria

Migration has been associated with a higher risk of STI/HIV but few studies have assessed the sexual risk behaviour of migrant farm workers in Nigeria. An exploratory survey was conducted to assess the knowledge of HIV/AIDS and sexual risk behaviours of migrant farmers in Saki West Local Government Area, Oyo State, Nigeria. Questionnaires were used to obtain information on socio-demographic and occupational characteristics, knowledge of HIV/AIDS, sexual behaviours and history of STI symptoms. Overall 518 respondents were interviewed, slightly over half were aware of HIV/AIDS; awareness was significantly lower among the females, those aged 15-24 years and those with no formal education. Majority (80.7%) were sexually experienced, the mean age at sexual debut was 19.4 +/- 5.2 years and 18.4 +/- 4.2 years for males and females respectively. Sexual intercourse with multiple sexual partners in the past year was reported by 24.6% (males, 35.7%, versus females, 10.4%, p < 0.05). Recent sexual intercourse with a casual partner was reported by 9.1% (12.8% males versus 4.4% females). Only 18.2% used a condom during the last casual sexual contact. Level of awareness of HIV is unacceptably low and sexual risk behaviours are prevalent among these workers. Appropriate sexual health and HIV prevention interventions should be instituted

Migration; Pastoralists; HIV Infection and Access to Care: the Nomadic Fulani of Northern Nigeria

The burden of HIV infection among the nomadic Fulani of northern Nigeria is unknown. Migration - a way of life for this population - is known to increase the rate of HIV transmission and may limit individuals' access to treatment and care. Many of Africa's other traditional; pastoral societies are similarly affected. This paper explores cultural practices and factors among the Fulani that may influence HIV transmission; vulnerability to infection; sustainability and challenges to treatment access; and avenues and models for outreach services; lastly; we proffer some solutions and recommendations. An extensive literature search with cross-referencing was done; and relevant publications on similar themes were reviewed. Three cases of Fulani nomads with HIV are presented to illustrate the challenge of providing a care continuum as well as to demonstrate successes when appropriate HIV interventions are employed. Patient interviews provide valuable insight and information on living and coping with HIV. Community mobility limits opportunities for counselling; testing and diagnosis; as well as HIV-related care access and maintenance. Consanguinity and certain cultural practices among the Fulani have clear amplification potential for HIV transmission. Treatment support through the use of coaches and life partners improves adherence to antiretroviral therapy (ART). Existing programmes for nomads afford opportunities for absorption and integration of HIV services. Nomadic communities should be provided with basic HIV-related services; including risk-reduction education and methods; counselling and testing; ART; medication adherence counselling; access to laboratory tests and health monitoring. These services should be taken to nomadic communities using novel approaches such as mobile units; extension services; case management; directly observed care; and treatment supporters linked to neighbouring health facilities in a hub-and-spoke model. Stronger collaborations are recommended between programmes for nomads and HIV services; and also between veterinary and public health services. Community participation and leadership should be encouraged to ensure the sustainability of HIV-related care delivery. More research is needed on the epidemiology and sociology of HIV infection and the best ways to provide services to hard-to-reach nomadic populations

A la recherche des determinants institutionnels du bien-etre des populations sedentaires et nomades dans la plaine du Waza-Logone de la frontiere camerounaise et tchadienne

This article describes an ongoing research project designed to compile a database to promote pastoral development in the lowlands along the Logone and Chari Rivers in Cameroon. A number of sedentary and nomadic populations depend on these flood plains south of Lake Chad for their livelihood. However the natural resources of the area undergo sharp seasonal variations and sometimes become the property of sedentary groups. As a result nomadic communities experience difficulty not only in gaining access to grazing lands and water but also to quality health care (hospital centers; effective medication). The purpose of this study was to define institutional requirements necessary to ensure access to health care resources for both nomadic and sedentary groups. The main problem for the nomadic population is that; unlike the now defunct precolonial structures; today's institutions are not compatible with the subsistence strategies of rural populations. These findingss u ggest that new institutional framewo rks for nat u ral resource management could indirectly improve the health status of nomadic pastoralist

Repartition de la morbidite dans trois communautes nomades du Chari-Baguirmi et du Kanem; Tchad

Within the framework of an multidisciplinary research and action program; morbidity patterns were assessed in three nomadic communities; i.e.; Fulani; A rab cattle bre e d e rs and A rab camel breeders; l iving in Chari - B ag u i rmi and Kanem; Chad. This is the first data about the health of Chadian nomadic pastoralists who account for approximately 6of the total population. A total of 1092 women; men and children were interviewed and examined in the course of three surveys carried out by a physician during the dry and rainy season. Nomads reporting no health problems were rare. Tuberculosis was suspected in 4;6of adults after clinical examination and bronchopulmonary disorders in children less than five years of age. Febrile diarrhea was more prevalent during the wet season when access to clean drinking water was more difficult. Simple malaria was rarely diagnosed in Arabs during the dry season. In contrast simple malaria was frequent in Fulani who stay inthe vicinity of Lake Chad during the dry period. Protein-energy malnutrition was observed in only 3 of 328 children younger than 15 years of age

Migration et Sida en Afrique de l'Ouest

L'article etudie la question des inter-relations entre le Sida et les phenomenes migratoires en Afrique de l'ouest

Measles in a West African nomadic community

A serological survey was conducted among Tuareg nomads to determine their level of immunity to measles. More than half (57.9%) of the children under 10 years of age did not have detectable antibodies to measles, suggesting that transmission of the disease is low in this mobile population. Mothers' reports of their children's history of measles were accurate (positive predictive value 93.9% for under-5-year-olds). Nomads are a reservoir of susceptible individuals who require immunization strategies adapted to their particular life-styles. These can be implemented at relatively low cost

Migration and health : refugees and returnees in Ethiopia

Health services to the refugees are based on a four-tier system linked by referral and supervisory arrangement and is consistent with the policy of the Ministry of Health. As with all refugee populations; the health status has to be compared with the levels achieved before immigration and also with those of the neighbouring host population. The health and nutritional status of the refugees under the care and maintenance programme; both in the East and West; is quite stable on the whole and at least comparable to; if not better than; that of the local population

Health aspects of the repatriation of displaced civilian population in war and drought-affected areas of Ethiopia

Medical experience in handling displaced people in Ethiopia is far-reaching. A solution to the lack in the flow; however; should be found particularly when displaced people are called to be moved from their normal ecological areas to newer ones. Since its inception in 1974; the Relief and Rehabilation Commission (RRC) has catered to several hundred thousand displaced civilians in conjunction with the Ministry of Health (MOH) and the donors' community. In fact; its actions have covered all administrative regions at one time or another in its 18 years of existence. Repatriation of displaced civilians has and still is one of the major tasks and responsibilities of the RRC in collaboration with other authorities and collaborating agencies concerned. Donors help health manpower capability building by sponsoring research undertakings including those studies of research related to repatriation