Strengthening healthcare through family medicine training in the Gambia: The journey so far

According to the World Health Organizations (WHO) family medicine forms the bedrock upon for accessible, affordable and equitable healthcare for any country. The need for family doctors is more acute for low income countries like The Gambia. More so that The Gambian health infrastructure is suboptimal and appropriate health personnel is low. This is worsened by brain drain leading to poor health indices. Despite these challenges and more, the department of Family Medicine was accredited for training in the Gambia with improved infrastructure (at the training centre), with 7 residents. Though there are still challenges there are also opportunities and strengths. There is therefore hope that the right personnel will be produced for an improved Gambian health system.

Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study

Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13 years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.

Gambia publications in the Science Citation Index Expanded: bibliometrics of institutions and subjects

Gambia is the smallest country in West Africa and it has contributed to the academic world over the past decades. This study characterized document type, language, publication trend, subject category, international collaboration of Gambia publications during 1900-2016 based on Science Citation Index Expanded in Web of Science. Results showed that Gambia is highly reliant on foreign and international collaboration in research, especially with the UK and USA. International collaboration was responsible for the increasing scientific production and scientific impact of Gambia over the years. Medical Research Council (MRC) contributed the most Gambia publications, and played an important role in conducting international collaboration. Most of Gambia publications focused on tropical medicine, environmental and occupational public health, immunology and infectious diseases. Gambia has attracted increasing attention from the academic world, with improving scientific production and scientific impact, signalling more prestige in the scientific community. With the information and insights provided in this paper, we managed to obtain a quick overview of Gambia publications that can help make strategic decisions for researchers and governors of scientific research.

Gambia es el país más pequeño de África occidental, pero ha contribuido con el mundo académico en las décadas pasadas. Este estudio caracteriza tipos de documentos, idioma, tendencias de publicación, temas y colaboración internacional de las publicaciones de Gambia entre 1900 y 2016, con base en el Science Citation Index Expanded en Web of Science. Los resultados indican que Gambia depende en gran medida de la colaboración internacional para publicar, principalmente del Reino Unido y EE.UU. Esta colaboración explica el aumento de la producción científica y el impacto científico de Gambia en los últimos años. El Medical Research Council (MRC) publicó el mayor número de artículos y ha cumplido una función importante en la colaboración internacional. La mayoría de publicaciones de Gambia se enfocan en medicina tropical, salud pública ambiental y ocupacional, inmunología y enfermedades contagiosas. Con la información y las observaciones de este artículo obtenemos una rápida visión general de las publicaciones de Gambia, que puede ayudar a investigadores y administradores a tomar decisiones estratégicas.

Hypertension-the Major Cause of Morbidity, Hospitalisation and Mortality among Non-communicable Diseases in the Gambia.

Aim: This study aimed at investigating the major cause of morbidity, hospitalisation and mortality among Non-communicable Diseases (NCDs) in The Gambia, in an effort to raise awareness on the alarming trend and thus stimulating appropriate responses from stakeholders. Method: Descriptive and inferential statistics were used to analyse a nation-wide routine hospital-based data on NCDs in The Gambia. Data were also presented in tables showing the trend of morbidity (in and out-patient case), hospitalisation and mortality between 2008 and 2011. Result: Hypertension as a risk factor for cardiovascular diseases constitutes more than half (55%) of all hospital admissions due to NCDs while cardiovascular diseases as a whole constitute well over 60% of all hospital admissions from NCDs. Of all NCDs studied, morbidity due to hypertension constitutes 80%, nearly responsible for all morbidities due to cardiovascular diseases for the years considered. Seventy percent (70%) of all deaths due to NCDs were caused by cardiovascular diseases, and hypertension was an important factor for NCDs related mortality (47.9% in 2008 to 55.8% in 2011;p-value=0.13). There were increments in morbidity and mortality due to hypertension and cardiovascular diseases between 2008 and 2011. However, there was reduction in hospitalisation due to cardiovascular diseases, but not the case with hypertension (incremental change). The differences in morbidity and hospitalisation were statistically significant for cardiovascular diseases (p<0.0001 and p=0.034 respectively) while only increment in morbidity due to hypertension was statistically significant (p<0.0001). Conclusion: This study shows that hypertension as a risk factor for cardiovascular disease is the greatest cause of morbidity, hospitalisation and mortality among NCDs in The Gambia. Hence, a holistic approach tailored towards preventing the acquisition/onset of the modifiable risk factors (of hypertension and CVD) should be instituted as well as programmes capable of preventing target organ damage among the population already affected.

Population-Based Interventions to Reduce the Public Health Burden Related with Hepatitis B Virus Infection in The Gambia, West Africa

In The Gambia, West Africa, the prevalence of chronic hepatitis B virus (HBV) infection in adults exceeds eight percent and hepatocellular carcinoma (HCC) has been the most frequent type of malignancy. Two population-based intervention studies to control HBV infection, namely, GHIS (Gambia Hepatitis Intervention Study) and PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), are discussed. The GHIS started in 1986 as a nation-wide trial of the HBV vaccine to evaluate the effectiveness of infant HBV vaccination in preventing HCC in adulthood. The vaccine was progressively introduced into the Expanded Program of Immunization (EPI) of The Gambia over four years in a phased manner, called the “stepped-wedge” design. This was because instantaneous universal vaccination in the country was impossible for logistic and financial reasons. However, this design also allowed the study to have an unvaccinated control group which consisted of the newborns of the areas where HBV vaccine has not yet been incorporated in the EPI. To assess the outcome, a national cancer registry was founded and all HCC patients in this birth cohort are linked with the vaccine trial database. The study is still ongoing to answer whether the HBV vaccine in infancy prevent HCC in adulthood in The Gambia. Although the universal HBV vaccination since 1990 has been successful in reducing the prevalence of chronic HBV infection in young Gambians, the number of HCC cases may not decline over the next decades as people infected prior to the immunization program are likely to continue to develop the diseases. To reduce the HCC incidence through community-based screening of HBV infection and provision of antiviral therapy, the PROLIFICA project started in 2011. Study hypothesis and design of these two studies, GHIS and PROLIFICA, are further discussed.

Population-based interventions to reduce the public health burden related with hepatitis B virus infection in The Gambia, West Africa

In The Gambia, West Africa, the prevalence of chronic hepatitis B virus (HBV) infection in adults exceeds eight percent and hepatocellular carcinoma (HCC) has been the most frequent type of malignancy. Two population-based intervention studies to control HBV infection, namely, GHIS (Gambia Hepatitis Intervention Study) and PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), are discussed.The GHIS started in 1986 as a nation-wide trial of the HBV vaccine to evaluate the effectiveness of infant HBV vaccination in preventing HCC in adulthood. The vaccine was progressively introduced into the Expanded Program of Immunization (EPI) of The Gambia over four years in a phased manner, called the “stepped-wedge” design. This was because instantaneous universal vaccination in the country was impossible for logistic and financial reasons. However, this design also allowed the study to have an unvaccinated control group which consisted of the newborns of the areas where HBV vaccine has not yet been incorporated in the EPI. To assess the outcome, a national cancer registry was founded and all HCC patients in this birth cohort are linked with the vaccine trial database. The study is still ongoing to answer whether the HBV vaccine in infancy prevent HCC in adulthood in The Gambia. Although the universal HBV vaccination since 1990 has been successful in reducing the prevalence of chronic HBV infection in young Gambians, the number of HCC cases may not decline over the next decades as people infected prior to the immunization program are likely to continue to develop the diseases. To reduce the HCC incidence through community-based screening of HBV infection and provision of antiviral therapy, the PROLIFICA project started in 2011. Study hypothesis and design of these two studies, GHIS and PROLIFICA, are further discussed.

Modelo de atención a la malnutrición crónica infantil en la región de Upper River, Gambia, según el marco Innovative Care for Chronic Conditions / Attention Model to chronic child malnutrition in the region of Upper River, Gambia, according to the Innovative framework Care for Chronic Conditions / Modelo de atenção à malnutrição crônica infantil na região de Upper River, Gâmbia, segundo o quadro Innovative Care for Chronic Conditions

La malnutrición es uno de los principales problemas de salud pública en la República de Gambia,con un 18 % de la población menor de cinco años afectada. El objetivo de este trabajo esofrecer una descripción y un análisis del conjunto de actores e instituciones y de sus políticase intervenciones involucradas en el abordaje de la malnutrición crónica infantil en la región deUpper River, Gambia. El mapa de atención a la malnutrición infantil se ha realizado a partirde una evaluación del modelo de atención vigente, siguiendo la herramienta Innovative Carefor Chronic Conditions Framework Situation Assessment de la Organización Mundial de laSalud, guiando el análisis por la experiencia profesional en este contexto del autor, y con elapoyo de la bibliografía consultada. Basado en los resultados, a modo de discusión se ofreceuna serie de intervenciones y estrategias de mejora del modelo en sus tres niveles de atencióna la malnutrición infantil...

Malnutrition is a major public health problem in the Republic of Gambia, with 18% of the populationunder five affected. The purpose of this paper is to provide a description and analysis of theset of actors and institutions, their policies and interventions involved in tackling child chronicmalnutrition in the region of Upper River, Gambia. The map of attention to child malnutritionhas been made from an assessment of the current care model, following the tool InnovativeCare for Chronic Conditions Framework Situation Assessment of the World Health Organization,guiding the analysis by professional experience in this context of the author, and with thesupport of the consulted bibliography. Based on the results, a series of interventions and strategiesfor improvement of the model in its three levels of care to child malnutrition is discussed...

A malnutrição é um dos principais problemas de saúde pública na República de Gâmbia, com um18 % da população menor de cinco anos afetada. O objetivo deste trabalho é oferecer descriçãoe análise do conjunto de atores e instituições e das suas políticas e intervenções envolvidasna abordagem da malnutrição crônica infantil na região de Upper River, Gâmbia. O mapa deatenção à malnutrição infantil realizou-se a partir de uma avaliação do modelo de atençãovigente, seguindo a ferramenta Innovative Care for Chronic Conditions Framework SituationAssessment da Organização Mundial da Saúde, guiando a análise pela experiência profissionalneste contexto do autor, e com apoio da bibliografia consultada. Baseado nos resultados, a modode discussão oferece-se uma série de intervenções e estratégias de melhoramento do modeloem seus três níveis de atenção à malnutrição infantil...

Caracterización clinicoepidemiológica y ecográfica de pacientes con masa hepática sólida / Clinical epidemiological and ultrasonic characterization of patients with solid liver mass

Se realizó un estudio descriptivo y transversal de 87 pacientes diagnosticados con masa hepática sólida, los cuales fueron atendidos en el hospital gambiano de Farafenni, de enero a diciembre del 2008, con vistas a caracterizarles desde los puntos de vista clinicoepidemiológico y ecográfico. Se analizaron variables sociodemográficas y clínicas. Se tuvieron en cuenta criterios de inclusión y exclusión. Además, se empleó el porcentaje como medida de resumen. En la serie predominaron el sexo masculino, el grupo etario de 45-59 años, la hepatitis viral B como el antecedente patológico, el dolor abdominal como la manifestación clínica más frecuente y desde el punto de vista ecográfico los nódulos múltiples y la infiltración difusa.

A descriptive and cross sectional study was carried out in 87 patients diagnosed with solid liver mass, who were attended in the hospital of Farafenni, Gambia, from January to December 2008, in order to characterize them from clinical, epidemiological and ultrasonic points of view. Sociodemographic and clinical variates were analyzed. Inclusion and exclusion criteria were considered. Also, the percentage as summary measure was used. Male sex, age group of 45-59 years, viral hepatitis B as medical history, and abdominal pain as the most frequent clinical manifestation and multiple nodes and diffuse infiltration as ultrasonic findings prevailed in the series.

Deserción escolar universitaria según el Nuevo Programa de Formación de Médicos en la comunidad gambiana de Bansang / University dropout according to the New Program of Doctors training in the Gambia community of Bansang

Se realizó un estudio descriptivo y transversal para evaluar cualitativa y cuantitativamente las causas de deserción escolar en los estudiantes de la unidad docente de Bansang en Gambia, pertenecientes al Nuevo Programa de Formación de Médicos en la Comunidad, del 2008 al 2009, así como la repercusión de este hecho en la nación africana. La matrícula estudiantil inicial en el primer año de la carrera de medicina en la citada provincia fue de 14 educandos y la final, de 12; en tanto, en todo el país el ingreso universitario resultó ser de 56 alumnos y al finalizar el curso esta cantidad descendió a 43. Entre las causas de la deserción escolar primó la económica.

A descriptive and cross sectional study to evaluate qualitatively and quantitatively the causes of dropout in the students of the teaching unit of Bansang in Gambia, belonging to the New Program for Doctors training in the community, from 2008 to 2009, as well as the repercussion of this fact in this African nation. The initial registration in the first year of the medicine career in the mentioned province was 14 students and the final one, of 12; while in the whole country the university entrance was 56 students and when the course ended this quantity decreased to 43. Among the causes of dropout the economy prevailed.

Determinants of Appropriate Child Health and Nutrition Practices among Women in Rural Gambia.

Health education and awareness involves providing knowledge about causes of illness and choices to promote a change in individual behaviour and, thus, improves survival of individuals. Studies have, however, shown that improved knowledge and awareness is not always translated into appropriate actions. This study aimed at exploring the factors determining mothers’ choices of appropriate child health and nutrition practices in the Gambia. Eight focus-group discussions (FGDs) were held with 63 women whose children had been seen at the Keneba MRC Clinic within the 12 months preceding the study. The FGDs were analyzed using a thematic framework. Gender inequality, presence or absence of support networks, alternative explanatory models of malnutrition, and poverty were identified as the main factors that would determine the ability of a mother to practise what she knows about child health and nutrition. The findings highlight the need to consider the broader social, cultural and economic factors, including the value of involving men in childcare, when designing nutritional interventions.