Acute rheumatic fever and rheumatic heart disease in resource-limited settings.

Poststreptococcal complications, such as acute rheumatic fever (ARF) and rheumatic heart disease (RHD), are common in resource-limited settings, with RHD recognised as the most common cause of paediatric heart disease worldwide. Managing these conditions in resource-limited settings can be challenging. We review the investigation and treatment options for ARF and RHD and, most importantly, prevention methods in an African setting.

Rabies post-exposure prophylaxis at a clinic in Fajara, The Gambia.

BACKGROUND: The Gambia is a popular holiday destination that is classified as a high-risk area for rabies exposure by the WHO. METHODS: This was a retrospective study of 49 subjects with rabies exposure attending The Medical Research Council Clinical Service, The Gambia, for treatment. Their demographics, details of exposure and treatment delivery were evaluated. RESULTS: An estimated 16% (8/49) of all exposures were likely to be from rabid animals. Moreover, 24% (12/49) of patients were tourists, none of whom had received pre-exposure prophylaxis. CONCLUSION: Rabies exposure is a serious risk for Gambians and visitors. Tourists should be advised about pre-exposure prophylaxis and risk reduction of rabies exposure.

Medical students' choices of specialty in The Gambia: the need for career counseling.

BACKGROUND: Understanding preferences for specialties by medical students and the factors driving choices assists policy makers in ensuring optimal spread of personnel across disciplines. METHODS: This cross-sectional survey using self-administered structured questionnaires was conducted on consenting students of the first medical school in The Gambia, established in 1999. Data collection was in June/July 2011. Questions were on sociodemographic characteristics of students, their parents, factors related to career preferences and opinions about counseling services. Data were analysed using JMP 8.0 software. RESULTS: Respondents were 52.4% of 202 eligible students. Mean age was 24.1 ± 5.0 years. Females constituted 54.7%. Muslims were 72.7% while Gambians formed 77.0%. Commonest specialties chosen by females were Obstetrics/Gynaecology, Paediatrics and Surgery in that order, while males preferred Internal Medicine, Surgery and Obstetrics/Gynaecology. Commonest factors influencing choices by females were 'focus on urgent care' (65.5%) and 'intellectual content of specialty' (56.9%). For males, these were 'intellectual content of specialty' (60.4%) and 'focus on urgent care' / 'individual's competence' (50.0% each). More females (30.0%) than males (23.0%) had ever received career counseling, but all students desired it. CONCLUSIONS: Significant gender differences exist in specialty choices and factors influencing these choices amongst these students. All want career counseling.