Digital health and self-management of chronic diseases in sub-Saharan Africa: A scoping review

Background: With the rise of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA), the concept of digital self-management presents great opportunities for relieving some of the burdens healthcare systems face. However, for this to be realised, effective use of digital health in self-management and assessment is essential. Objective: The objective of this scoping review was to identify social determinants and cognitive factors with potential influence on digital health use in self-management of chronic medical conditions associated with NCDs in SSA. Method: The 5-stage scoping review framework was used to search, identify, and filter publications over a 10-year period from two major databases, Google Scholar and Pubmed. Based on the inclusion criteria, a total of 12 documents were chosen for analysis. Results: Findings reveal that social determinants such as cultural values and societal practices demand a rethinking of how digital health for self-management of chronic diseases are designed and developed for use in SSA, whereas a cognitive factor such as self-efficacy is central in digital health use in self-management of chronic conditions, particularly in areas like adherence to medication, diet and exercise programmes. Conclusion: Owing to the unique characteristics of digital health users in SSA, technologies and content (particularly those for self-management of chronic diseases) should be tailored to the diverse needs of the population. It is through this that the region can fully benefit from the potential of digital health use in self-management of chronic diseases associated with NCDs.

After-action review of rabies and anthrax outbreaks multisectoral response in Tanzania, challenges and lessons

After-action review uses experiences gained from past events to adopt best practices, thereby improving future interventions. In December 2016 and late 2018, the government of Tanzania with support from partners responded to anthrax and rabies outbreaks in Arusha and Morogoro regions respectively. The One Health Coordination Desk (OHCD) of the Prime Minister's Office (PMO) later coordinated after-action reviews to review the multi-sectoral preparedness and response to the outbreaks. To establish and describe actions undertaken by the multi-sectoral investigation and response teams during planning and deployment, execution of field activities, and outbreak investigation and response, system best practices and deficiencies. These were cross-sectional surveys. Semi-structured, open and closed-ended questionnaire and focus group discussions were administered to collect information from responders at the national and subnational levels. It was found that the surveillance and response systems were weak at community level, lack of enforcement of public health laws including vaccination of livestock and domestic animals and joint preparedness efforts were generally undermined by differential disease surveillance capacities among sectors. Lack of resources in particular funds for supplies, transport and deployment of response teams contributed to many shortfalls. The findings underpin the importance of after-action reviews in identifying critical areas for improvement in multi-sectoral prevention and control of disease outbreaks. Main sectors under the coordination of the OHCD should include after action reviews in their plans and budget it as a tool to continuously assess and improve multi-sectoral preparedness and response to public health emergencies.

Current norms and practices in using a seizure diary for managing epilepsy: A scoping review

Epilepsy is a chronic and debilitating condition affecting people of all ages in many nations. Healthcare practitioners look for effective ways to track patients' seizures, and a seizure diary is one of the methods used. This scoping review sought to identify current norms and practices for using seizure diaries to manage epilepsy. Method: A scoping review was performed by screening relevant studies and identifying themes, categories and subcategories. Results: A total of 1125 articles were identified from the database; 46 full-text articles were assessed for eligibility, of which 23 articles were selected. The majority (48%) of the studies were prospective studies. The majority (65%) of the articles were studies conducted in the United States. The themes identified were types of seizure diaries used in clinical practice, contents and structure of a standardized seizure diary, the use and efficacy of seizure diaries in medicine and challenges relating to using a seizure diary for patient management. Conclusion: The study revealed that a seizure diary remains a relevant tool in managing epilepsy. The two forms of diaries in use are electronic and paper-based diaries. The high cost of data and the expensive devices required to access electronic diaries make it unsuitable in a resource-limited setting. Despite its disadvantages, imperfections and inadequacies, the paper-based diary is still relevant for managing patients with epilepsy in resource-limited settings. Contribution: This study reviewed the literature to find the current norms and practices in using seizure diaries. The benefits of the different formats were emphasized

Impact of maternal periodontitis on preterm birth and low biirth weight in babies: results of a scoping review

Background Periodontitis has been documented as public health concern but its association with preterm and low birth weight remains uncertain, thus the objective of this scoping review is to summarize the most recent published evidence related to the impact of periodontitis on preterm birth and low birth weight in order to improve public awareness and to inform policies for oral health during pregnancy. Methods Hinari, PubMed, and Google Scholar were searched to acquire the published literature. The retrieved studies included cross-sectional, case control studies and randomized controlled trials with available full text published in English from 2008 to 2019. Results After combining the key words, 333 articles were identified with only 133 eligible articles published from 2008 to 2019. After reviewing the available 50 full text articles, duplicates were removed and 15 studies fully met the inclusion criteria. There were 13 articles that supported the association between maternal periodontitis and preterm low birth weight while 2 found no evidence to support the association. Conclusion The results of this scoping review contribute to an increasing body of evidence to support the hypothesis that maternal periodontal disease may be a risk factor for preterm delivery and low birth weight.

The legislative and regulatory framework governing herbal medicine use and practice in Kenya: a review

Complementary and alternative medicine is an integral component of primary healthcare in Kenya. This is because the infrastructural health setup in the country is inadequate in catering for all the medical needs of the population. This particularly holds true in the rural areas where many rural folk rely on products of herbal origin to offset their healthcare needs. More often than not these products are an elaborate cacophony of several different substances of biological origin and thus need personnel adept in their preparation. Sadly, due to loopholes in legislation and regulation, quacks have a field day in the practice. Moreover, the process of planting, harvesting, preparation and storage of herbs and related products dictates that a significant number of people will ultimately be involved in the whole process. This is likely to set the stage for manipulation and compromise of the safety, quality and efficacy of these products. This state of affairs appears unabated especially in the context of the current legal and regulatory framework governing herbal medicine use and practice in Kenya. Not only are these laws inadequate, they are shrouded in ambiguity, open to interpretation and the authorities mandated to implement them often end up performing duplicate roles. The aim of this review is to critique the legal and regulatory provisions governing herbal medicine use and practice in Kenya. In conclusion, laws and regulations meant to control herbal medicine use and practice in Kenya are wanting. Clear and definitive legislation on herbal medicine use and practice coupled with effective implementation by mandated institutions will go a long way in inspiring confidence to all stakeholders of herbal medicine

RMJ research series: literature searching

MY EXPERIENCE:Christian is a year 5 medical student in Rwanda embarking on his first research project.I had never undertaken a formal literature search until my 5th year of medical studies, I was therefore very much challenged by how rigorous it was. For the fist time, I had to use websites like PubMed, Cochrane to find the information I needed. This replaced my usual sources of information which had been Wikipedia and Google. I then had to learn how to use a reference manager, Mendeley, to store and cite the papers I found. I was using it and so many terms I hadn't heard of before. It was all unfamiliar to me.I found it really difficult to find relevant papers in PubMed and because of the scarcity of papers and poor internet connection I found it really discouraging.Organizing articles and summarizing them was the hardest of all. Multiple pages of conference reports, articles and surveys all were to be transformed into relevant systematically coordinated summary.As a solution to these problems I used the Mendeley literature search which contains an abundance of articles. I then hand-searched the bibliographies of the articles I had found. To overcome problems of internet connection I would work in places with strong Wi-Fi and spend the whole day nonstop searching and downloading everything ready for offline reading and reviewing.So, as a result, my research project got quicker, more organized, more comprehensible and I found this really satisfying

Comorbidities and Neuromyelitis Optica - Spectrum Diseases : What are the current Data ?

Neuromyelitis optica (NMO-SD) or Devic disease is an acute transverse myelitis associated with an optic neuritis united -or bilateral. It is an inflammatory disease very disabling evolving by thrust. The long-term prognosis is also difficult to predict due to comorbidities which determine the evolution and the quality of life of patients. The objective of our study was to determine the different types of co-morbidities found in patients with NMO -SD.Methods: It was a descriptive study through a review of the literature on PubMed with the combination (Neuromyelitis optica, comorbidity). The data analysis was made on the software SPSS 23 Results: Total 27 articles were published and available on PubMed (June 2017). Among these 27 work we included ten (10) specific studies of co-morbidities in the NMO-SD. Three categories of illnesses have been reported in these 10 articles including coexisting diseases with the NMO-SD without any risk factor common or similar

Hydatidosis in Morocco: review of literature and epidemiology

Hydatidosis or hydatid cyst is a prevalent zoonosis all over the world due to larval forms of the tapeworm of the genus Echinococcus. Echinococcus granulosus is the most frequent form of echinococcal infection in humans. The disease generally results from an oral ingestion of the parasite ova eliminated with feces of dogs leading to the emergence of hydatid cysts.Hydatidosis is a health problem that may remain asymptomatic for several years. This disease is endemic in Morocco and is recorded to be a serious problem that requires great caution

Review of past and present ebola hemorrhagic fever outbreaks in the Democratic Republic of Congo 1976 -2014

Background: Ebola Hemorrhagic Fever (EHF) has become well known all over the world; especially following the West African outbreak in Guinea; Sierra Leone and Liberia (December 2013). The Ebola virus was first discovered in the Democratic Republic of Congo (DRC); an African country that has continued to register Ebola outbreaks. This study aims to summarize old and new experiences of Ebola in the DRC; in order to propose strategies for better prevention.Materials and Methods: Information was taken from databases such as PubMed and Cochrane library. A total of eleven full text and three abstracts were identified for the data extraction. Results: Since its discovery in the DRC; there have been seven Ebola outbreaks; accounting for a total of 1032 cases and 795 deaths. The presence of Non-Human Primates; also considered as the natural reservoir and susceptible host of Ebola virus; can be one major factor that has contributed to the increased number of Ebola outbreaks and cases in the Equatorial region. The existence of rumors and legends related to Ebola in DRC obscure the the viral nature of the disease; and lead to difficulty for health workers; to easily accomplish their tasks.Conclusion :It is important ;to scale up community education campaigns designed to give more details on the viral nature of the EHF; establish national agencies and institutions specialized in controlling hunting in the Equatorial region; for better prevention; since there is not yet a specific drug or vaccine to the Ebola Virus

Whole blood pathogen reduction technology and blood safety in sub-saharan Africa: a systematic review with regional discussion

Background: Despite vast improvements in transfusion services in sub-Saharan Africa over the last decade, there remain serious concerns on the safety and adequacy of the blood supply across the region. Objective: This review paper ascertains the role of pathogen reduction technology (PRT) in improving blood safety and supply adequacy in the region. Method: The state of blood safety in sub-Saharan Africa was reviewed. Meetings, seminars and correspondence were undertaken with key clinicians, scientists and professional bodies in the region, including the World Health Organization's Regional Office for Africa, to examine the suitability of PRT for improving the safety of whole blood transfusion, a prevalent transfusion format in the region. Results: Existing literature suggests that combining PRT with current blood safety measures(such as serology) would improve the safety and adequacy of the blood supply for transfusions in sub-Saharan Africa. This was echoed by the findings of the stakeholder meetings. Conclusion: Following a detailed appraisal of two leading PRT systems, the Mirasol® PRT System and the Cerus S-303 System, we suggest that companies conduct comprehensive toxicological evaluation of the agents used for PRT and publish this in the scientific literature. We also recommend that the safety and efficacy of these technologies should be established in a randomised clinical trial conducted in sub-Saharan Africa

A Review of Chronic Lung Disease in Neonates at Charlotte Maxeke Johannesburg Academic Hospital from 1 January 2013 to 31 December 2014

Background. Chronic lung disease (CLD) remains a significant morbidity in preterm babies despite advances in neonatal care. The use of postnatal corticosteroids (PNCSs) to treat CLD remains controversial.Objectives. To describe the clinical characteristics of babies with CLD at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to explore the use of PNCSs for the prevention and treatment of CLD.Methods. This was a 2-year retrospective review of neonates admitted to CMJAH. Neonates who were in hospital for =28 days were included. Comparisons were made between neonates with evolving CLD and those with no CLD.Results. A total of 485 neonates were analysed: 237 had evolving CLD and 245 did not have CLD. Overall incidence of evolving CLD was 5%. More neonates with CLD than those without CLD needed resuscitation at birth (48.5% v. 39.8%; p=0.02) and had low 5-minute Apgar scores (17.2% v. 10.6%; p=0.001). Neonates with CLD had increased prevalence of patent ductus arteriosus (30.4% v. 7.7%; p=0.001) and late-onset sepsis (56.5% v. 23.6%; p=0.001). The mortality rate was also higher in CLD babies (10.2 v. 2.4%; p=0.001). Necrotising enterocolitis (NEC) (29.2% v. 8%; p=0.005) and sepsis (83.3% v. 53.8%; p=0.008) were associated with increased mortality. The use of PNCSs was associated with less NEC (3.5% v. 17.2%; p=0.001) and improved survival (95.6% v. 81.7%; p=0.001).Conclusions. CLD remains a common morbidity in neonates despite advances in neonatal care. The use of PNCSs was shown to have short-term benefits. To get the most out of PNCS use for CLD; further studies need to be conducted to determine the safest type of steroid; safe doses and the duration of treatment

A Review of the Peri-Operative Management of Paediatric Burns: Identifying Adverse Events

Background. Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission; according to burn admission criteria; about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small; residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis; bleeding; issues around thermoregulation; the hypermetabolic state; nutritional and electrolyte issues; inhalation injuries and the amount of movement during procedures to wash patients; change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures.Objective. To review the peri-operative management and standard of surgical care of burnt children.Methods. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital; Cape Town; South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified.Results. There were 257 males and 301 females in this study; with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%; with an average of 23.5%. Inhalational injury was present in 11.3%; pneumonia in 13.1%; wound sepsis in 20.8%; and septicaemia in 9.7%; and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0oC. Core temperatures recorded at the start; halfway through and at completion of surgery were 36.9oC; 36.8oC and 36.5oC; respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL; respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children.Conclusion. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control; rapid blood loss; preceding respiratory illnesses and measures to reduce blood loss

Tumours of the Chest in Children: A Review

Tumours of the chest in children constitute an array of pathology and clinical symptomatology. These tumours can be benign or malignant; cystic or solid; primary or as a result of secondary metastases. Collectively; tumours of the chest in children are very rare; the exact incidence of which is largely unknown globally. Non neoplastic lesions of the lung including bronchogenic cysts; sequestrations; congenital pulmonary airway malformations as well as infective and inflammatory disorders are 60 times more common than neoplastic causes.1 A tumour of the chest is considerably difficult to diagnose since patients can be asymptomatic for many years before symptoms evolve. Even more so; the symptoms are non-specific and can suggest more common and less sinister pathology. Clinically patients present with a variety of symptoms that depend largely on the location of the tumour.Airway tumours can be symptomatic or can present with chronic cough; wheeze; haemoptysis; atelectasis or persistent pneumonia. Secondary malignant parenchymal tumours are likely to be symptomatic from the primary lesion. Anterior mediastinal tumours can cause compression of the large airways or superior vena caval structures.It stands to reason that the physician needs to have a very high index of suspicion when dealing with these non-specific signs and symptoms. This article provides an approach to tumours of chest and reviews the common aetiology in the different compartments of the chest. The article will focus on common tumours of the airway; lung parenchyma; mediastinum; cardiac and chest wall pathology

Eosinophilic Lung Disease: A Review

The terms 'eosinophilic pneumonia' and 'eosinophilic lung disease' loosely describe a heterogeneous group of pulmonary diseases of varying aetiologies and severity. The diseases are characterised by infiltration of lung parenchyma by eosinophils; peripheral eosinophilia is not required for diagnosis. In this article; major clinical entities are appraised with respect to clinical; pathological and radiological features. Diseases without pulmonary infiltration or radiographic abnormalities; such as allergic asthma; are not included in this review

Role of Genetics in the Etiopathogenesis of Genetic Generalized Epilepsy: A Review of Current Literature

"Until recently; genetic generalized epilepsy (GGE) was believed to be of presumed genetic etiology with no identifiable genetic mutation or demonstrable epigenetic abnormality. A wide range of epileptic disorders has clue for an inherited susceptibility. Monogenic disorders associated with epilepsy mental retardation and structural brain lesion typified by heterotopias; tuberous sclerosis; and progressive myoclonus epilepsies account for about 1 of epilepsies. This review focuses on the role of genetic mutations and epigenetic rearrangements in the pathophysiologic mechanism of GGE. To achieve this; PubMed; EMBASE; and Google Scholar were systematically and comprehensively searched using keywords (""epilepsy"" ""juvenile myoclonic epilepsy (JME);"" ""typical absences;"" ""idiopathic generalized epilepsy;"" ""JME;"" ""juvenile absence epilepsy;"" ""childhood absence epilepsy"" ""generalized tonic-clonic seizure"" ""GTCS""). Most GGE has evidence of underlying genetic inheritance. Recent animal studies have shown that early detection and treatment of genetic generalized epilepsies can alter the phenotypic presentation in rodents. These findings suggest a critical period in epileptogenesis; during which spike-and-wave seizures can be suppressed; leading to chronic changes in the brain (epileptogenesis) and the preceding dysfunctions may; therefore; be targeted using therapeutic approaches that may either delay or inhibit the transition to active epileptic attack. The interplay between genetic mutations and epigenetic rearrangements play important roles in the development of GCE and that this process; especially at crucial developmental periods; is very susceptible to environmental modulations"

Hypoglycaemia in Children: Review of the Literature

Hypoglycaemia is a common metabolic condition in children. It often presents urgent and therapeutic challenges and it has been documented to affect many childhood conditions. Its clinical presentation is not classical and requires a high index of suspicion for an early diagnosis and prompt management. Undiagnosed or undertreated hypoglycaemia has been found to increase mortality in children when it is present. This review sought to review the subject of hypoglycaemia in children and calls for testing for it in all sick and admitted children

Pulmonary Tuberculosis Sequelae: Spectrum of Radiologic Findings and Review of Literature

Pulmonary tuberculosis (TB) is a common worldwide infection and a medical and social problem causing high mortality and morbidity; especially in developing countries.In accordance with the virulence of the organism and the defenses of the host; tuberculosis can occur in the lungs and in extrapulmonary organs. A variety of sequelae and complications can occur in the pulmonary and extrapulmonary portions of the thorax in treated or untreated patients.In this article; we aimed to review the characteristic imaging findings of various sequelae of thoracic tuberculosis affecting the lung parenchyma; airways; vessels; mediastinum; pleura; and chest wall

Neurologic emergencies in resource-limited settings: a review of stroke care considerations

Background: The current guidelines and evidence supporting acute stroke management have limitations in resource austere environments despite being a leading cause of death worldwide. Developing countries face a rapidly increasing and disproportionate burden of cerebrovascular disease yet differences in setting and resource limitations bring challenges that have a major influence in management options - especially with routine imaging and interventional considerations. In addition; general awareness; diagnosis and management of stroke remain poor.Objectives :To outline current acute stroke management and critical interventions that should be integrated into current practice while highlighting resource-limited care considerations.Methods :A systematic search of Ovid MEDLINE and reference lists of the literature on stroke; guidelines; and acute stroke management including care considerations in resource-limited settings was conducted through March 2014. Recommendations :Within emergency medicine; emphasis should be placed on establishing a robust stroke assessment and care process that is resource appropriate and scalable. Adherence as resources allow to current stroke care guidelines including acute management; stroke center coordination; palliation and resource allocation may improve outcomes. Further research related to resource-limited management is essential. Risk reduction through population-based interventions and early recognition may help to reduce the burden of disease

Hyperglycaemic emergencies in pregnancy: case reports and literature review

Two cases are presented of diabetic ketoacidosis (DKA) occurring in newly presenting gestational diabetes mellitus (GDM) in Nigeria. Both were associated with foetal death; and the cases emphasise the need for efficient GDM screening and patient education. GDM is increasing in frequency; and the 2013 World Health Organization (WHO) Guidelines give simple and applicable guidelines for screening; diagnosis; and management. Even glycosuria testing can be helpful at a primary care level. The reoccurrence of GDM is also high (up to 50% of cases); and such women should be encouraged to seek early antenatal care in subsequent pregnancies