ABSTRACT
Abstract Objective: to analyze the use of the Practical Approach to Care Kit as a technology adopted in nurses' clinical practice for HIV management in Primary Health Care. Method: an exploratory and descriptive research study anchored in the methodological framework of the Constructivist Grounded Theory. The participants were defined through initial sampling, with 12 nurses, and theoretical sampling, with five managers, totaling 17 participants. The data were collected by means of intensive interviews and documentary analysis, and they were analyzed in two stages: 1) Initial coding; and 2) Focused coding. Results: the professionals identified the Practical Approach to Care Kit as a technological innovation that contributed to expanding the clinical practice and to empowering nurses in the clinical management of HIV infection. They also highlighted its importance as a tool for guiding the different responsibilities and duties while sharing care, contributing to the provision of evidence-based practices. Conclusion: The Practical Approach to Care Kit is a technological innovation that has transformed nurses' clinical practice in HIV management, expanding their scope of activities in carrying out the diagnosis, assessing the health condition and counseling, evaluating adherence to the treatment, adverse effects and prescription of exams, medications, and immunobiological.
Resumo Objetivo: analisar a utilização do Practical Approach to Care Kit como uma tecnologia adotada na prática clínica dos enfermeiros no manejo do HIV na Atenção Primária à Saúde. Método: pesquisa exploratória e descritiva, ancorada no referencial metodológico da Teoria Fundamentada nos Dados Construtivista. A definição dos participantes foi realizada por amostragem inicial, com 12 enfermeiros, e amostragem teórica, com cinco gestores, totalizando 17 participantes. Os dados foram coletados por entrevistas intensivas e análise documental, e foram analisados em duas etapas: 1) codificação inicial; e 2) codificação focalizada. Resultados: os profissionais identificaram o Practical Approach to Care Kit como uma inovação tecnológica que contribuiu para a ampliação da prática clínica e empoderamento do enfermeiro no manejo clínico da infecção por HIV. Também destacaram sua importância como ferramenta para orientação das diferentes responsabilidades e atribuições no compartilhamento do cuidado, contribuindo para a prestação de práticas baseadas em evidências. Conclusão: o Practical Approach to Care Kit é uma inovação tecnológica que transformou a prática clínica do enfermeiro no manejo do HIV, ampliando seu escopo de atividades na realização do diagnóstico, avaliação da condição de saúde e aconselhamento, avaliação da adesão ao tratamento, efeitos adversos e prescrição de exames, medicamentos e imunobiológicos.
Resumen Objetivo: analizar el uso del Practical Approach to Care Kit como tecnología adoptada en la práctica clínica de los enfermeros en el manejo del VIH en la Atención Primaria de la Salud. Método: investigación exploratoria y descriptiva, basada en el marco metodológico de la Teoría Fundamentada en los Datos Constructivistas. La definición de los participantes fue realizada por muestreo inicial, con 12 enfermeros, y muestreo teórico, con cinco gestores, fueron 17 participantes en total. Los datos fueron recolectados a través de entrevistas intensivas y análisis de documentos, y fueron analizados en dos etapas: 1) codificación inicial; y 2) codificación enfocada. Resultados: los profesionales identificaron el Practical Approach to Care Kit como una innovación tecnológica que contribuyó a la expansión de la práctica clínica y al empoderamiento de los enfermeros en el manejo clínico de la infección por VIH. También destacaron su importancia como herramienta para orientar las diferentes responsabilidades y obligaciones en la distribución de la atención de los pacientes, contribuyendo a la prestación de prácticas basadas en evidencia. Conclusión: el Practical Approach to Care Kit es una innovación tecnológica que ha transformado la práctica clínica de los enfermeros en el manejo del VIH, ampliando su radio de acción para la realización del diagnóstico, evaluación del estado de salud y asesoramiento, evaluación de la adherencia al tratamiento, efectos adversos y prescripción de exámenes, medicamentos e inmunobiológicos.
Subject(s)
Humans , Primary Nursing , Professional Practice , HIV Infections/therapy , Practice Guideline , Disease Management , Nursing, TeamABSTRACT
Introduction. Le cancer du col utérin est le deuxième cancer de la femme au Cameroun. La radiothérapie reste une des modalités thérapeutiques phares dans la prise en charge de cette pathologie et l'État participe en y apportant une subvention. Toutefois, plusieurs patientes n'accèdent pas au traitement en raison des difficultés financières. Notre objectif était d'évaluer le coût réel de la prise en charge afin de servir de support aux politiques d'aide aux patientes. Méthodologie. Uneétude descriptive, transversale portant sur les patientes traitées en radiothérapie à l'Hôpital Général de Douala pour cancer du col de l'utérus a été réalisée d'octobre 2020 à janvier 2021.Résultats. Au total 35 dossiers de patientes ont été inclus. Lespatientes avaient de faibles revenus (<108.810 XAF /mois, 51,3%), étaient sans assurance maladie (88,6%), provenant en majorité des villes hors de Douala (54,3%), avec des cancers localement évolués. Le coût global moyen du traitement était de 511 264 XAF+/-103479 XAF (779,42 +/-157,75 euros) pour chaque patiente. La durée moyenne de traitement était de 57,34 jours, avec un nombre médian de 27 séances. Les frais supplémentaires pendant le traitement provenaient de la chimiothérapie, de la gestion des effets secondaires, notamment des transfusions sanguines, et du bilan de suivi. Plus de la moitié des patientes ont eu besoin d'une prise en charge supplémentaire par chimiothérapie ou chirurgie. Conclusion. La prise en charge du cancer du col utérin par radiothérapie est coûteuse et peu accessible à la majorité des patientes Camerounaises.
Introduction.Cervix cancer is the second cancer among women in Cameroon. Radiotherapy is often warranted in its management. Many patients do not access treatment due to financial difficulties. Our objective was to assess the real cost of care in order to support patient assistance policies. Methodology. A descriptive cross over study of women treated by radiotherapy at the Douala General Hospital from October 2020 to January 2021 was conducted. Results. A total number of 35 patient files were included in the study. Patients generally had low income (<108.810 XAF /month), without medical insurance, lived out of Douala, and were diagnosed at locally advanced stages of their disease. Average cost of treatment for radiotherapy alone was 511,264 XAF +/-103,479 XAF. Average duration of treatment was 57.34 days, with a median number of 27 sessions. Extra cost came from chemotherapy, management of side effects especially from blood transfusions, and imaging. More than half of the patients required additional expense for adjunct chemotherapy or surgery. Conclusion. The total cost of treatment for cervix cancer by radiotherapy is quite expensive, and not accessible to the average Cameroonian
Subject(s)
Humans , Female , Radiotherapy , Uterine Cervical Neoplasms , Health Care Costs , Disease Management , Costs and Cost AnalysisABSTRACT
Introduction. Ces vingt dernières années, on assiste à une augmentation spectaculaire du nombre de cas de diabète de type 1 avec une mortalité plus élevée en Afrique Noire en lien avec les difficultés d'accès aux soins, à la rupture de suivi engendrant un nombre élevé de perdus de vue. L'objectif du travail est de déterminer le profil épidémiologique des enfants diabétiques perdus de vue dans notre pratique. Patients et méthodes. C'est une étude transversale à visée descriptive et analytique qui a concerné les enfants diabétiques perdus de vue de 2002 à 2019 dans le service de diabétologie du CHU de Yopougon. Résultats. Durant l'étude 195 enfants ont été suivi dans le service, 90 ont été considérés comme perdus de vue soit une fréquence de 46,15 %. L'âge moyen des perdus de vue était de 14,6 ± 5,3 avec des extrêmes allant de 2 à 20 ans. Ils sont majoritairement de sexe F dans 50,6 %. Dans 37 % on retrouve un niveau socio-économique faible calculé selon l'indice IPSE avec une association statistiquement significative entre les classes socio-économiques moyenneinferieure et moyenne (p respectivement < 0,01 et 0,001). La plupart des perdus (84,5 %) n'ont pas d'assurance maladie. Le lieu de résidence était urbain (Abidjan) dans 73 %. Ils ont issus d'une famille biparentale dans 79 ,8 % des cas. Une association statistiquement significative a été retrouvée entre la non-scolarisation et la perte de vue (P < 0,05).Conclusion. Le manque de suivi chez les enfants diabétiques a des conséquences drastiques sur le pronostic de la maladie au long cours, marqué par une mortalité de 11 % qui touche essentiellement les populations à revenu faible
Introduction. Over the past twenty years, there has been a spectacular increase in the number of cases of type 1 diabetes with a higher mortality rate in Black Africa due to difficulties in accessing care but also a lack of follow-up resulting in a high number of people being lost to follow-up. Our work aims to determine the epidemiological profile of diabetic children lost to follow-up. Patients and methods. This was a cross-sectional study with descriptive and analytical aims which concerned diabetic children lost to follow-up from 2002 to 2019 in the diabetes department of the University Hospital of Yopougon. Results. During the study period, 195 children were followed up in the department, 90 were considered as lost to follow-up, i.e. a frequency of 46.15%. The average age of the lost to follow-up was 14.6 ± 5.3 years with extremes ranging from 2 to 20 years. The majority of them were male (50.6%). Thirty-seven percent had a low socioeconomic level calculated according to the IPSE index, with a statistically significant association between the lowermiddle and middle socioeconomic classes (p < 0.01 and 0.001 respectively). Most of the lost (84.5%) did not have health insurance. The place of residence was urban (Abidjan) in 73%. They came from a two-parent family in 79.8% of cases. A statistically significant association was found between non-education and loss of sight (P < 0.05). Conclusion. The lack of follow-up in diabetic children has drastic consequences on the prognosis of the disease in the long term marked by a mortality of 11% which affects mainly low-income populations.
Subject(s)
Humans , Male , Female , Child , Adolescent , Epidemiology , Disease Management , Diabetes Mellitus , Diagnosis , Lost to Follow-Up , Social Class , Continuity of Patient CareABSTRACT
Introduction. Les hémopathies malignes sont des proliférations anormales et anarchiques de cellules hématopoïétiques à point de départ médullaire ou périphérique. Notre étude qui avait pour objectif de faire le bilan de la prise en charge des hémopathies malignes au Centre national d'oncologie médical et de radiothérapie Alassane Ouattara. Méthodes. Il s'agissait d'une étude rétrospective descriptive d'une durée de 2 ans 3 mois allant du 1er janvier 2018 au 31 Mars 2020 portant sur 80 dossiers de malades porteurs d'hémopathies malignes et prise en charge dans le centre. Résultats. Notre étude a permis de recenser 2,2% d'hémopathies malignes sur les 3650 cas de pathologies cancéreuses recensées au CNRAO, soit une incidence 26,66 cas/an avec un sex-ratio 1,2. Les syndromes lymphoprolifératifs (SLP) sont les plus fréquents (96,25 %), sous trois principales formes: lymphomes malins non hodgkiniens (LMNH) non Burkitt (51,25%), leucémie myéloïde chronique (20%) et le myélome multiple (16,25%). Les LMNH représentent 51,25% des HM recensées avec 41,46 % de lymphomes de haut grade de malignité. La chimiothérapie était de mise chez tous nos patients. Ainsi sur 41 cas de LMNH, seulement 12 (29,27%) ont bénéficié du protocole R-CHOP. On notait 46,34% de réponse complète. Dans notre étude, le LH représentait 8,75% il était traité à 71,43% avec le protocole ABVD avec une réponse complète chez 6 patients. 37,5% des patients porteurs de leucémie myéloïde chronique ont reçu le Rituximab; ils ont été traités par les protocoles COP (31,25%), CHOP (31,25%), RCVP (12,5%) et R-CHOP (25%). La réponse thérapeutique était complète à 68,75%. Le protocole utilisé dans le traitement du myélome multiple a été le VMCD-REV à 76,92% avec pour réponse thérapeutique complète chez 6 patients, 3 réponses partielles et 4 en cours de traitement. Conclusion. Les SLP qui sont les plus fréquents des HM avec trois principales formes: LMNH non Burkitt, leucémie myéloïde chronique et myélome multiple. Nous avons cependant des difficultés quant à la mise en route de la chimiothérapie.
Introduction. Hematologic neoplasms are abnormal and anarchic proliferations of hematopoietic cells with a medullary or peripheral starting point. Our study aimed to report the management of hematological malignancies at the Centre National d'Oncologie Médicale et de Radiothérapie Alassane Ouattara (CNRAO). Methods. This was a descriptive retrospective study lasting 2 years 3 months from January 1st, 2018 to March 31st, 2020 concerning 80 patients with hematologic neoplasms who were managed in the CNRAO. Results. Hematologic neoplasms represented 2.2% of cancers (80/3650) at CNRAO, giving an annual incidence of 26.66 cases. The sex ratio was 1.2. Lymphoproliferative syndromes were the most common subgroups (96.25%). These were mainly non-Burkitt non Hodgkin lymphoma (51.25%), high grade lymphomas (41.46%), chronic lymphocytic lymphoma (20%) and multiple myeloma (16.25%). Chemotherapy was administered to all patients. Among 41 cases of non-Hodgkin lymphoma, 12 (29.27%) benefited from the R-CHOP protocol and full response was observed in 46.34% of them. We found 7 patients with Hodgkin lymphoma (8.75%) and the ABVD protocol was used for 6 cases (71.43%). Six out of these seven patients were in complete response. Among the 16 patients with chronic lymphocytic leukemia, 6 (37.5%) received Rituximab. The distribution of the patients with chronic lymphocytic leukemia was as follows: COP 31.25%, CHOP 31.25%, RCVP 12.5% and R-CHOP 25% and 68.75% had full response. The most common treatment protocol for multiple myeloma was VMCD-REV (76.92%). Six patients had complete response, 3 had partial response and 4 were in the course of treatment. Conclusion. In our practice, hematologic neoplasms are mainly lymphoproliferative syndromes and the most common varieties are non-Burkitt non Hodgkin lymphoma, high grade lymphomas, chronic lymphocytic lymphoma and multiple myeloma. We have difficulties in getting chemotherapy started.
Subject(s)
Humans , Male , Female , Hematologic Neoplasms , Disease Management , Lymphoma , Lymphoma, Non-Hodgkin , Hematologic DiseasesABSTRACT
Background: Third-party disability (TPD) has been studied in multiple patients including those with aphasia and hearing loss. Only one study has been done in relation to caregivers of adults with dysphagia. Third-party disability has been analysed using the International Classification of Function and Disability (ICF) framework. This study, therefore, used the ICF model to explore TPD of caregivers of adults with dysphagia for the context of Johannesburg in South Africa. Objectives: To describe how caregivers experience TPD when caring for adults with a dysphagia in Johannesburg. Methods: Data were collected from five primary adult caregivers, who were all family members, from government clinics in Johannesburg. This article reports the findings from the interviews that were analysed thematically using a top-down analysis approach. Results: Caregivers experienced challenges related to TPD mostly related to difficulties of being able to do activities of daily living for themselves, their household chores and attending social engagements. The use of body structure and function from the ICF model was not overtly applicable to the caregiver population. A new visual representation has been suggested to highlight the key themes to augment the social and psychological changes as seen on the ICF framework and demonstrated the specific interaction that these factors had on one another. Conclusion: Third-party disability is present in caregivers of patients with dysphagia. Healthcare workers need to be aware of the impact that this can have when preparing home management strategies. This newly devised representation can assist in creating a locally relevant patient-centred care approach but requires future input.
Subject(s)
Deglutition Disorders , Health Strategies , Disease Management , Hearing Loss , Family Characteristics , CaregiversSubject(s)
COVID-19 , Cameroon , Disease Management , Bilateral Cooperation Programs , Financial Management , Healthcare FinancingABSTRACT
Objective: To understand the demands caused by chikungunya in the chronic phase and their impacts on patients' mental health and quality of life. Materials and methods: This is a qualitative study, performed from November 2019 to January 2020. Focus groups and deep interviews were carried out. Then, the Discourse Analysis was performed. Results: Chronic pain was the main clinical manifestation reported by the participants, being responsible for affecting aspects related to quality of life and mental health. As for psycological view, this study showed that chronic pain was also reported as one of the main symptoms related to anxiety and depression among research subjects. Conclusion: this study demonstrated how the chronic illness caused by Chikungunya impacted the subjects' perception in the domains related to quality of life and mental health. Furthermore, we seek to focus on the management of disease in a holistic way, putting the patients' own awareness of the impacts of the disease on their lives in a relevant level of their treatment.
Objetivo: Compreender as demandas causadas pela chikungunya em sua fase crônica e seus impactos na saúde mental e na qualidade de vida dos pacientes. Métodos: Trata-se de um estudo com abordagem qualitativa, realizado entre novembro de 2019 a janeiro de 2020. Inicialmetne, foram realizados grupos focais e entrevistas em profundidade; seguidas da Análise do Discurso. Resultados: A dor crônica foi a principal manifestação clínica relatada pelos participantes, sendo responsável por afetar aspectos relacionados à qualidade de vida e saúde mental. Quanto ao aspecto psicológico, este estudo mostrou que a dor crônica também foi relatada como um dos principais sintomas relacionados à ansiedade e depressão entre os sujeitos da pesquisa. Conclusão: este estudo demonstrou como a doença crônica causada pela chikungunya impactou na percepção dos sujeitos em seus domínios relacionados à qualidade de vida e saúde mental. Além disso, procuramos centrar-nos na gestão da doença de forma holística, colocando a consciência dos próprios doentes sobre os impactos da doença nas suas vidas num nível relevante do seu tratamento.
Subject(s)
Chikungunya Fever , Patients , Quality of Life , Signs and Symptoms , Therapeutics , Public Health , Focus Groups , Disease Management , Chronic PainABSTRACT
Introducción: el síndrome de Turner es una enfermedad genética caracterizada por la pérdida total o parcial de un cromosoma X, siendo sus características fundamentales la talla baja, la disgenesia gonadal y hallazgos fenotípicos característicos. Tiene una amplia variabilidad en su forma de presentación. Grandes estudios epidemiológicos muestran que la morbilidad aumenta en mujeres con este síndrome, debido a una amplia gama de enfermedades asociadas, sobre todo cardiovasculares, que eleva la mortalidad de manera significativa. Objetivo: realizar una revisión de la literatura, en base a la presentación de un caso clínico, para recabar información sobre las ultimas pautas de manejo y presentar los nuevos objetivos de tratamiento. Conclusiones: el diagnóstico temprano es fundamental, y tiene características propias y criterios de sospecha según la etapa en la que se efectúa, el reto actual en el manejo de estas pacientes consiste en la formación de un equipo médico multidisciplinario, conformado por una amplia gama de especialistas para el adecuado seguimiento, con el fin de disminuir las complicaciones y ayudar a que la paciente alcance sus objetivos para una vida plena. Se presenta el caso de una paciente con síndrome de Turner vista por el equipo médico en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell, Montevideo-Uruguay.
Introduction: Turner's syndrome is a genetic disease characterized by total or partial loss of an X chromosome, its main features being low height, gonadal dysgenesis and characteristic phenotypic findings. It has a wide variability in its form of presentation. Large epidemiological studies show that morbidity increases in women with this syndrome, due to a wide range of associated diseases, especially cardiovascular disease, which significantly raises mortality. Objectives: to carry out a review of the literature, based on a clinical case in order to gather information regarding the latest treatment guidelines and present the new treatment goals. Conclusions: early diagnosis is essential, and has its own characteristics and suspicion criteria according to the stage in which it is carried out. The present challenge regarding the management of these patients consists of the training of a multidisciplinary medical team made up of a wide range of specialists able to carry out proper follow-up, in order to reduce complications and help the patient live a full life. We present a case of a patient with Turner's syndrome assisted at the Pereira Rossell Hospital Center in Montevideo-Uruguay.
Introdução: a síndrome de Turner é uma doença genética caracterizada pela perda total ou parcial de um cromossomo X, sendo suas características fundamentais de baixa estatura, disgenesia gonadal e achados fenotípicos característicos. Tem uma ampla variabilidade em sua forma de apresentação. Consideráveis (grandes, amplos, extensos) estudos epidemiológicos mostram que a morbidade aumenta em mulheres com essa síndrome, devido a uma ampla gama de doenças associadas, especialmente cardiovasculares, o que aumenta significativamente a mortalidade. Objetivos: realizar uma revisão da literatura, a partir da apresentação de um caso clínico, reunir informações sobre as últimas diretrizes de tratamento e apresentar os novos objetivos do tratamento. Conclusões: o diagnóstico precoce é fundamental, e possui características próprias e critérios de suspeita de acordo com a etapa em que é realizado, o desafio atual na gestão desses pacientes consiste na formação de uma equipe médica multidisciplinar, formada por uma ampla gama de especialistas para o acompanhamento adequado, a fim de reduzir complicações e ajudar a paciente a alcançar uma vida plena. Apresentamos o caso de uma paciente com síndrome de Turner atendido pela equipe médica do Hospital Pediátrico do Centro Hospitalar Pereira Rossell, Montevidéu-Uruguai.
Subject(s)
Humans , Female , Child, Preschool , Turner Syndrome/diagnosis , Turner Syndrome/drug therapy , Human Growth Hormone/administration & dosage , Disease Management , Early DiagnosisABSTRACT
Objective: There was a lot of panic when the COVID-19 pandemic started because a lot was not known about it. However, as the disease unfolded, proven scientific universal precautions are recommended to curb its spread. Methods: This was a cross-sectional online survey of people living in Nigeria. Questionnaires were distributed to consenting participants using the SurveyMonkey and data was collected on sociodemographic knowledge of the aetiology and prevention of COVID-19. Analysis was done with the SPSS version 25. Results: Eighty-five participants with age ranging from 18 to 60 years took part in the study. The mean age was 37.35 ± 11.7years. Forty-seven (47%) had knowledge that COVID-19 infection is from a virus. 29.4% thought it is caused by biological weapons, 1.2% from 5G internet, 7.1% as government's ploy to embezzle money and 9.4% conspiracy theory from the world leaders to reduce world's population. All participants knew that hand washing is a preventive measure against the spread of COVID-19 and majority agreed to the use of sanitizers, social distancing and disinfection of surfaces. Only 30.6% agreed that wearing of facemasks will serve as a preventive measure. Over 90% of the participants agreed that dissemination of appropriate information, use of universal precautions, isolation and intensive treatment of those infected can help prevent the spread of COVID-19. 11.8% of participants knew that additional precautions are needed for aerosol generating procedures. Conclusion: The knowledge of COVID-19 aetiology is poor among the populace and the need to wear face masks as a preventive measure in curtailing the spread of COVID-19 needs to be emphasized.
Subject(s)
Humans , Male , Female , Public Opinion , Knowledge , Personal Protective Equipment , COVID-19 , Public Health , Disease ManagementABSTRACT
BACKGROUND: Acute ischemic stroke has been reported to occur in a significantly higher number of COVID-19 patients as compared to healthy controls with variable proposed pathophysiologic mechanisms. To our knowledge, sufficient data regarding this subject is lacking in Ethiopia and the African continent at large. In this case series, we report the clinical characteristics and management of 5 cases with COVID-19 infection and acute ischemic stroke to shed light on the diagnostic and therapeutic challenges in resource-limited setups. METHODS: This is a case series including data collected from the medical records of 5 participants with confirmed RT-PCR positive COVID-19 infection and radiologically confirmed acute ischemic stroke, admitted at Eka Kotebe General Hospital Intensive Care Unit (ICU) in Addis Ababa, Ethiopia from June 10, 2020, to November 04, 2020. RESULTS: Cryptogenic stroke was documented in 4/5 participants included in this series with the most common vascular risk factors identified for stroke being hypertension and diabetes mellitus. The median time from onset of COVID-19 symptoms to the identification of stroke was 07 days. Two fifth of the participants in this series died during their ICU admission with the immediate cause of deaths reported to be related to the severe COVID-19 infection but not stroke. CONCLUSION: Cryptogenic stroke was documented in 4/5 patients in this series despite the presence of vascular risk factors for other stroke subtypes. The overall prevalence, subtypes, and outcomes of stroke in COVID-19 patients in Ethiopia and the African continent as a whole needs additional research to elucidate the local burden of the disease and define the predominant pathophysiologic mechanisms for stroke in COVID-19 in the region
Subject(s)
Humans , Male , Female , Clinical Diagnosis , Ischemic Stroke , COVID-19 , Disease ManagementABSTRACT
La République démocratique du Congo (RDC), frappée par la pandémie de la COVID-19, a mis en place un plan de riposte national au regard du premier objectif de ce plan pendant la première année de crise. Cette étude a passé en revue les différentes composantes de la surveillance et certains piliers du système de santé, éléments critiques pour la compréhension des résultats de la riposte aujourd'hui et future. Un manque d'efficience a été observé dans les chaines internes de communication lié à une faible coordination des intervenants et de leurs interventions ; et des ressources financières insuffisantes. Malgré ces faiblesses la RDC a évité la catastrophe annoncée. Divers facteurs liés à l'environnement, à la structure d'âge de sa population, au niveau de circulation du virus au sein de cette population et d'autres à élucider dans les recherches futures pourraient contribuer à la compréhension de la situation actuelle et influencer la gestion future de gestion des épidémies. Il est évident qu'une meilleure coordination et mobilisation des ressources, ainsi qu'un système de santé résiliant, permettront une meilleure surveillance et une gestion moins stressante des crises sanitaires à venir.
The Democratic Republic of Congo (DRC), hit by the COVID-19 pandemic, has put in place a national response plan. We reviewed the organization of the response in light of the first objective of this plan during the first year of the crisis. This study reviewed the different components of surveillance and some pillars of the health system, which are critical to understanding the results of the response today and in the future. There was a lack of efficiency in internal communication chains due to poor coordination of stakeholders and their interventions; and insufficient financial resources. Despite these weaknesses, the DRC has avoided the announced disaster. Various factors related to the environment, the age structure of its population, the level of circulation of the virus within this population and others to be elucidated in future research could contribute to the understanding of the current situation and influence the future management of epidemics. It is clear that better coordination and resource mobilization, as well as a resilient health system, will allow for better surveillance and less stressful management of future health crises.
Subject(s)
Humans , Male , Female , Primary Health Care , Public Health , Disease Management , Delivery of Health Care , COVID-19 , PandemicsABSTRACT
Background: Non-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparse. Aim: This study aimed to assess the impact of COVID-19 on facility and community-based NCD care and management during the first COVID-19 wave. Setting: Two public health sector primary care sites in the Cape Town Metro, including a Community Orientated Primary Care (COPC) learning site. Methods: A rapid appraisal with convergent mixed-methods design, including semi-structured interviews with facility and community health workers (CHWs) (n = 20) and patients living with NCDs (n = 8), was used. Interviews were conducted in English and Afrikaans by qualified interviewers. Transcripts were analysed by thematic content analysis. Quantitative data of health facility attendance, chronic dispensing unit (CDU) prescriptions and routine diabetes control were sourced from the Provincial Health Data Centre and analysed descriptively. Results: Qualitative analysis revealed three themes: disruption (cancellation of services, fear of infection, stress and anxiety), service reorganisation (communication, home delivery of medication, CHW scope of work, risk stratification and change management) and outcomes (workload and morale, stigma, appreciation and impact on NCD control). There was a drop in primary care attendance and an increase in CDU prescriptions and uncontrolled diabetes. Conclusion: This study described the service disruption together with rapid reorganisation and change management at primary care level during the first COVID-19 wave. The changes were strengthened by the COPC foundation in one of the study sites. The impact of COVID-19 on primary-level NCD care and management requires more investigation.
Subject(s)
Quality of Health Care , Delivery of Health Care , Noncommunicable Diseases , COVID-19 , Disease Management , Diabetes Mellitus, Type 2 , HypertensionABSTRACT
Introduction : La CoViD-19 est une maladie à « plusieurs visages ¼ qui peut affecter tous les systèmes. La survenue d'hémorragies digestives fait partie des manifestations de cette maladie. L'objectif de cette étude est de présenter les cas d'hémorragies digestives chez des patients infectés par le SARS-CoV-2. Matériels et Méthodes : Une étude rétrospective couvrant la période correspondant aux deux vagues de CoViD-19 à Antananarivo (Madagascar) a été réalisée, plus particulièrement au service de Réanimation Chirurgicale du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona. Résultats : Huit sur 101 patients de 51 à 81 ans, hospitalisés pour CoViD-19, ont présenté une hémorragie digestive dont les manifestations allaient de l'hématémèse au méléna ou une association de ces deux manifestations hémorragiques. Ces patients ont été traités par, entre autres une anticoagulation et une corticothérapie, comme défini dans le protocole national de prise en charge de la CoViD-19, avant l'épisode hémorragique. Aucun patient n'a présenté d'état de choc, l'indice de choc allait de 0,5 à 0,9. Deux patients ont pu bénéficier d'une fibroscopie digestive haute. Le score de Glasgow Blatchford variait de 6 à 13. Parmi ces huit patients, quatre sont décédés. Conclusion : Lors de la prise en charge de la CoViD-19, au vu des manifestations thrombotiques surtout, il faut procéder à une protection au niveau digestif lorsqu'une anticoagulation à titre curatif doit être réalisée. Également cette protection digestive doit être effectuée au-devant de la corticothérapie, laquelle entre dans le cadre du traitement de la CoViD-19. Tout cela pour minimiser le risque de survenue de saignement gastro-intestinal .
Background: CoViD-19 is a "many-faced" disease that can affect all the body organism. The occurrence of gastrointestinal bleeding is one of the manifestations of this disease. The aim of this study was to present cases of gastrointestinal bleeding in patients infected with SARS-CoV-2. Materials and Methods: A retrospective study covering the period corresponding to the two waves of CoViD-19 in Antananarivo (Madagascar) was carried out, more particularly in the Surgical Intensive Care Unit of the University Hospital Joseph Ravoahangy Andrianavalona. Results: Eight out of 101 patients aged 51 to 81, hospitalized for CoViD-19, presented gastrointestinal bleeding, with hematemesis or melena or a combination of these two bleeding manifestations. These patients were treated, among other coagulation and corticosteroid therapy as defined in the national protocol for the management of CoViD-19 before the bleeding episode. None of the patients presented with a shock; the shock index ranged from 0.5 to 0.9. Two patients were able to benefit from an upper digestive fibroscopy. The Glasgow Blatchford score ranged from 6 to 13. Of these eight patients, four died. Conclusion: During the management of CoViD-19, the thrombotic manifestations are treated with curative anticoagulation must be performed, which can cause digestive bleeding. Also, in front of the corticosteroid therapy which is part of the treatment of CoViD-19, also digestive protection must be carried out to minimize the risk of occurrence of gastrointestinal bleeding.
Subject(s)
Polymerase Chain Reaction , Disease Management , COVID-19 , Gastrointestinal Hemorrhage , Pandemics , SARS-CoV-2ABSTRACT
Background: Colorectal cancer (CRC) is one of the most common malignancies seen in the Western World. It is increasing in developing countries due to adaptation of the western lifestyle with an incidence of 6% in Nigeria. Treatment options are dependent on the stage of disease at presentation, the performance status of the patient, and increasingly the molecular makeup of the tumor. There is a dearth of data on the treatment options obtainable for the management and outcome of CRC cases in Northwestern, Nigeria. Aim: The study assessed the treatment options and outcome of colorectal cancer patients in a tertiary institution, in Northwestern, Nigeria over a 10-year period. Patients and Methods: Between January 2006 and December 2015, data of one-hundred and twenty-two histologically confirmed colorectal cancer cases seen at the Surgery, Radiotherapy and Oncology Departments, ABUTH Zaria, were retrieved retrospectively from the case files and treatment cards of the patients at the health information unit of the hospital. The stage at disease presentation, treatment received, and outcome were analyzed. Results: Nearly a quarter of the patients fell within the age bracket 3140 years with the median age being 41 years. While only 41% of the patients had their disease staged, 30.4% of the patients presented with advanced disease (Dukes'C + D). Only 95 cases received a form of surgery or the other. Colostomy however accounted for 28.4%. Eighty-nine of the patients received chemotherapy either as neoadjuvant, adjuvant or with palliative intent. External beam radiotherapy either with radical or palliative intent was received by 60 patients (49.2%). At 1-year follow-up sixty cases had been lost to follow up, and thirty-six cases had defaulted on one form of treatment. Conclusion: The study showed that stage at presentation and the available treatment options in the hospital informed treatment offered to the patients. However, surgery was readily performed due to the pattern of presentation and most patients benefited from just a diverting colostomy. Majority of the patients presented with rectal tumor which required radiotherapy as part of its treatment modality, although this is still a luxury in this part of the world. Chemotherapy is also readily available and often prescribed. Cost and limited facility for biomarker (K-ras) testing restrict the use of targeted therapy. Outcome at 1-year follow-up was poor with whereabouts of nearly half of the patients unknown.
Subject(s)
Humans , Radiotherapy , Socioeconomic Factors , Colorectal Neoplasms , Disease Management , Drug Therapy , Hospitals, TeachingABSTRACT
Background: Sickle cell disease (SCD) is associated with chronic haemolysis, immuno-suppression and susceptibility to infections, which may trigger infection-associated haemolysis (IAH). SCD patients are vulnerable to anaemic effect of IAH due to vicious interaction between pre-existing 'inherited' chronic haemolysis and 'acquired' IAH. IAH in SCD manifests as febrile haemolytic crisis with clinical and laboratory features of severe anaemia or pancytopenia. Clinico-pathological perspectives of IAH in SCD are fragmented. This review presents a comprehensive but concise overview of pathogenesis, management and prevention of IAH in SCD. Methodology and results: Online literature search using search terms such as 'sickle cell disease, viral, bacterial, parasitic, fungal, infections, hyperhaemolytic crisis, haemophagocytic syndrome, severe anaemia, pancytopenia' in various combinations was done on PubMed/Medline, Google, Google-Scholar and Bing. Overall, 112 relevant publications were retrieved, which included 109 peer reviewed journal articles, 2 World Health Organization (WHO) technical reports, and 1 edited text book. A range of bacterial (Bartonella spp, Mycoplasma spp., Mycobacterium avium complex), viral (Dengue, SARS-CoV-2, Parvovirus-B19, Cytomegalovirus, Epstein-Barr virus), parasitic (Plasmodium spp., Babesia spp.), and fungal (Histoplasma spp.) infections were associated with IAH in SCD. There are two broad types of IAH in patients with SCD; infection associated extra-medullary haemolysis (IAEMH) and infection associated intra-medullary haemolysis (IAIMH). While IAEMH is associated with severe anaemia due to intravascular haemolysis caused by red cell invasion, oxidative injury, auto-antibodies, and/or pathogen-haem interaction, IAIMH is associated with haemophagocytic tri-lineage destruction of haematopoietic precursors in the bone marrow. Conclusion: Various microbial pathogens have been associated with IAH in SCD. SCD patients with fever, severe anaemia or pancytopenia should be investigated for early diagnosis and prompt treatment of IAH, which is a lifethreatening haematological emergency for which transfusion therapy alone may not suffice. Prompt and sustainable termination of IAH may require therapeutic combination of transfusion, anti-microbial chemotherapy, and immune modulation therapy. SCD patients should also receive counselling on hygiene, barrier protection against vectors, routine chemoprophylaxis for locally endemic diseases, and immunization for vaccine-preventable infections as a long-term preventive strategy against IAH.
Subject(s)
Humans , Hemolysis , Anemia, Sickle Cell , Disease Management , InfectionsABSTRACT
Contexte et objectifs. Les hépatites virales chroniques constituent un problème de santé publique en Côte-d'Ivoire. Très peu de malades accèdent au traitement en raison des coûts élevés du bilan et du traitement. L'objectif de la présente étude était d'évaluer les coûts du bilan et du traitement des hépatites virales chroniques. Méthodes. Il s'agissait d'une étude observationnelle transversale analytique réalisée, du 1er mars 2019 au 31 juillet 2019, en consultation d'hépato-gastroentérologie du CHU de Yopougon. Les variables étudiées étaient les paramètres sociodémographiques et économiques. Résultats. Au total, 136 patients (hommes 53, 6 %, âge moyen de 42 ans ± 12,2) ont été inclus. Plus de la moitié des patients (63,3 %) avaient un revenu mensuel n'excédant pas 490.39 USD. Le coût du bilan initial était de 223.13 USD et de 351.14 USD respectivement, pour l'hépatite virale B et C. Le ténofovir et l'interféron pégylé étaient gratuits. Le traitement par sofosbuvir + velpastavir coûtait 593.37 USD. Le bilan de suivi annuel était estimé à 237.02 USD pour l'hépatite virale B, 225.58 USD pour l'hépatite virale C. Conclusion. Le bilan et le traitement des hépatites virales chroniques ont un coût prohibitif pour les patients malgré la couverture maladie universelle.
Context and objectives. Chronic viral hepatitis is a public health problem in Côte-d'Ivoire. A significant number of patients have little access to treatment due to the high costs of assessment and treatment. The objective of our study was to evaluate the costs of assessments and treatment of chronic viral hepatitis. Methods. This was an analytical cross-sectional observational study from March 1, 2019 to July 31, 2019 in the HepatoGastroenterology Consultation Service at the Yopougon University Hospital. The variables studied were socio-demographic and economic parameters. Results. 136 patients (men 53.6 %, average age 42 ± 12.2 years) were included. More than half of the patients (63.3 %) had a monthly income not exceeding 490.39 USD. The cost of the initial assessment was 223.13 USD and 351.14 USD for viral hepatitis B and C, respectively. Tenofovir and pegylated interferon were free of charge. Treatment with sofosbuvir + velpastavir cost 593.37 USD. The annual follow-up assessment was estimated at 237.02 USD for viral hepatitis B and 225.58 USD for viral hepatitis C. Conclusion. The assessment and treatment of chronic viral hepatitis have a cost that remains high for patients despite the universal health coverage.
Subject(s)
Humans , Male , Female , Health Care Costs , Disease Management , Hepatitis C, Chronic , Diagnosis , Hepatitis B , Hepatitis, Viral, HumanABSTRACT
Introduction. Les infections respiratoires aiguës (IRA) sont des pathologies ubiquitaires très fréquentes, touchant aussi bien les adultes que les enfants. L'inclusion des vaccins conjugués, contre les pneumocoques et l'Haemophilus influenzae type B a modifié l'épidémiologie en réduisant la prévalence de ces bactéries dans les atteintes infectieuses respiratoires, la prédominance virale est devenue la règle. Notre travail avait pour objectif d'identifier les principaux virus responsables d'IRAS chez les enfants au service de pédiatrie de Donka de décrire la prise en charge des enfants. Patients et méthodes. Étude descriptive prospective de 6 mois allant du 01 Avril au 30 Septembre 2022 incluant les enfants admis au service pour IRAS dont une PCR a été réalisée sur prélèvement nasopharyngé. Résultats. Une proportion de 3,3% des 1584 enfants avaient une IRA virale. 51,1% avaient moins de 5 ans. La proportion des filles était de 63,05% et 76,09% des enfants étaient vaccinés selon le programme élargi de vaccination (PEV). Les motifs de consultation les plus fréquents étaient : fièvre, difficulté respiratoire, asthénie physique, myalgie et toux. La bronchiolite était le diagnostic le plus fréquent. Le diagnostic clinique et radiologique était dominé par la bronchiolite, la bronchopneumonie et la pneumonie. La PCR était positive dans 3,26% des cas dont 2/3 pour le virus influenza et 1/3 pour le coronavirus. Le paracétamol, l'oxygénation, l'antibiothérapie et le sérum physiologique dominaient le traitement. Conclusion. La prévalence des IRA reste élevée avec une faible implication virale. Une étude plus poussée comprenant la microbiologie des prélèvements nasopharyngés et la PCR est nécessaire
Introduction. Acute respiratory infections (ARI) are very common ubiquitous pathologies, affecting both adults and children. The inclusion of conjugate vaccines, against pneumococci and Haemophilus influenzae type b, has changed the epidemiology by reducing the prevalence of these bacteria in respiratory infectious diseases, viral predominance has become the rule. The aim of our study was to identify the main viruses responsible for ARI in children at the Donka Pediatric Department and to secribe the management of patients. Patients and methods. This was a prospective descriptive study of 6 months from 01 April to 30 September 2022 including children admitted to the service for IRAS whose PCR was performed on nasopharyngeal swab. Results. A proportion of 3.3% of the 1584 children had viral SARI. 51.1% were under 5 years of age. The proportion of girls was 63.05% and 76.09% of children were vaccinated according to the EPI. The most common reasons for consultations were fever, difficulty breathing, physical asthenia, myalgia and cough. Bronchiolitis was the most common diagnosis, Clinical and radiological diagnosis was dominated by bronchiolitis, bronchopneumonia and pneumonia. PCR was positive in 3.26% of cases including 2/3 for influenza virus and 1/3 for coronavirus. Paracetamol, oxygenation, antibiotic therapy and saline dominated treatment. Conclusion. The prevalence of SARI remains high with low viral involvement. Further study including bacteriology of nasopharyngeal specimens and PCR is needed