Abstract: Introduction: Rwanda has made significant advancements in medical and economic development over the last 20 years and has emerged as a leader in healthcare in the East African region. The COVID-19 pandemic, which reached Rwanda in March 2020, presented new and unique challenges for infectious disease control. The objective of this paper is to characterize Rwanda’s domestic response to the first year of the COVID-19 pandemic and highlight effective strategies so that other countries, including high and middle-income countries, can learn from its innovative initiatives.Methods: Government publications describing Rwanda’s healthcare capacity were first consulted to obtain the country’s baseline context. Next, official government and healthcare system communications, including case counts, prevention and screening protocols, treatment facility practices, and behavioral guidelines for the public, were read thoroughly to understand the course of the pandemic in Rwanda and the specific measures in the response.Results: As of 31 December 2020, Rwanda has recorded 8,383 cumulative COVID-19 cases, 6,542 recoveries, and 92 deaths since the first case on 14 March 2020. The Ministry of Health, Rwanda Biomedical Centre, and the Epidemic and Surveillance Response division have collaborated on preparative measures since the pandemic began in January 2020. The formation of a Joint Task Force in early March led to the Coronavirus National Preparedness and Response Plan, an extensive six-month plan that established a national incident management system and detailed four phases of a comprehensive national response. Notable strategies have included disseminating public information through drones, robots for screening and inpatient care, and official communications through social media platforms to combat misinformation and mobilize a cohesive response from the population.Conclusion: Rwanda’s government and healthcare system has responded to the COVID-19 pandemic with innovative interventions to prevent and contain the virus. Importantly, the response has utilized adaptive and innovative technology and robust risk communication and community engagement to deliver an effective response to the COVID-19 pandemic. Published on 2021-02-25 09:49:38
Abstract: Background: Hepatitis B virus (HBV) infection disproportionally affects populations in sub-Saharan Africa. Lack of HBV awareness perpetuates disease burden in Africa.Objective: To promote HBV awareness in Tanzania using a systematic, measurable, and expandable approach to educating health care workers (HCW).Methods: We designed and implemented an HBV knowledge and teaching skills session in southern Tanzania to empower HCWs in leading education to promote disease awareness in their communities. Training was divided into two sessions: didactic and practical. A fivequestion anonymous survey was distributed in person immediately before and after the practical portion of the training to evaluate HBV knowledge as well as specific skills for teaching. Differences between responses before and after the sessions were evaluated by Chi-Square analysis. A sub-group of questions were further analyzed for differences based on HCW self-report of HBV serostatus awareness.Findings: 130 HCWs participated in the didactic lecture and 30 HCWs participated in both portions. A pre-post training five-question survey showed an increase in correct answers for all questions, with two showing statistical significance: HBV is silent (7% pre vs. 87% post; p < 0.0001), and repetition as key to promote awareness (63% pre vs. 100% post; p = 0.0002).Conclusions: Our low-cost intervention is applicable to increase HBV awareness in low resource settings across Africa. Published on 2021-02-25 09:23:44
Abstract: This Viewpoint calls for a greater understanding of the role that water plays in the transmission of anti-microbial resistance and covid-19 in protracted urban armed conflict, in order to develop a ‘pathogen-safe’ practice. It argues that dealing with the twin threats is difficult enough in the best of circumstances, and is so little understood in war zones that surgeons and water engineers now question if their practice does more harm than good. Experience suggests that the known transmission routes are complicated by a great number of factors, including the entry of heavy metals through bullets in patients’ wounds, hospital over-crowding, mutation in treated water or wastewater, and other threats which endure long after the bombing has stopped. The skeleton research agenda proposes greater sewage surveillance, testing of phages and monitoring of treatment designed to dispel or substantiate these assertions. Published on 2021-02-24 09:28:02
Abstract: Background: Subspecialty expertise is often lacking in clinical environments in low-resource settings. As a result, medically complicated patients can receive suboptimal care, local clinicians can feel inadequately supported, and global health engagements can be difficult for medical trainees accustomed to more expert supervision at their home institutions.Objective: We created WhatsApp Messenger discussion groups to connect subspecialists at the University of California, Los Angeles (UCLA) David Geffen School of Medicine with clinicians and rotating global health residents at Partners in Hope (PIH) Medical Center in Lilongwe, Malawi.Methods: Case submitters and subspecialist respondents were surveyed about their experience in the discussion groups.Findings: Over a three-year period, 95 cases were discussed in ten subspecialty groups, with dermatology and radiology/pulmonology receiving the most submissions. Participants were surveyed and reported excellent educational outcomes; large majorities of both case submitters (89%) and experts (71%) agreed or strongly agreed that the case discussions improved their medical education. The surveys also suggested positive impact on medical management decisions and patient outcomes. The major challenge to our intervention was low utilization of this resource by Malawian clinicians in comparison to medical residents. We hope to further address the barriers to participation and adapt the intervention to better support our Malawian colleagues.Conclusion: Because the discussion groups are free to create and require very little maintenance, this intervention can be easily replicated at other institutions looking to augment their global health educational engagements and support their clinical partners abroad. Published on 2021-02-18 12:16:01
Abstract: Background: Male involvement during antenatal care is an influential strategy for improving maternal health service utilization, especially institutional delivery. In Ethiopia, only one-fifth of pregnant women were accompanied to antenatal care. It is among those neglected issues, as it is not well studied, specifically determinant factors of male involvement during antenatal care are not known.Objective: This study aimed to identify the determinants of male partner involvement during antenatal care among pregnant women in Gedeo Zone, South Ethiopia.Methods: Community based unmatched case-control study was carried out from January to March 2019 among 804 (cases-402 and controls-402) selected pregnant women having antenatal follow up in Gedeo zone by stratified sampling technique. Data was collected using a pretested, structured, interviewer-administered questionnaire. A survey was conducted in the 22 selected kebeles in the Gedeo zone to identify cases and control. The data was entered using Epi-data and exported to SPSS (Statistical Package for Social Sciences) for analysis. Descriptive analysis like frequency, percentage, rates, and inferential analysis such as binary logistic regression are used. Statistical significance is declared at á < 0.05. The result is presented using text and tables.Results: Husband and maternal age difference (AOR = 1.12, 95% CI [1.06, 1.18]), maternal age at marriage (AOR = 0.86, 95% CI[0.81,0.93]), women empowerment (AOR = 0.20, 95% CI[0.13, 0.30]), type of nearby health facility (AOR = 4.94, 95% CI[1.67, 14.60]) and provider invitation of male partner to antenatal care examination room (AOR = 0.32, 95% CI[0.20, 0.51]) were determinants of male partner involvement during antenatal care.Conclusions: Age difference between husband and wife, age at marriage, women empowerment, type of nearby health facility and male invitation by health providers to antenatal care examination room determines male partner antenatal care involvement. Promoting women empowerment and inviting a male partner to antenatal care are recommended to encourage male involvement during antenatal care. Published on 2021-02-17 11:13:12
Abstract: Background: Atrial fibrillation is the most common arrhythmia in post-industrialized populations. Older age, hypertension, obesity, chronic inflammation, and diabetes are significant atrial fibrillation risk factors, suggesting that modern urban environments may promote atrial fibrillation.Objective: Here we assess atrial fibrillation prevalence and incidence among tropical horticulturalists of the Bolivian Amazon with high levels of physical activity, a lean diet, and minimal coronary atherosclerosis, but also high infectious disease burden and associated inflammation.Methods: Between 2005–2019, 1314 Tsimane aged 40–94 years (52% female) and 534 Moseten Amerindians aged 40–89 years (50% female) underwent resting 12-lead electrocardiograms to assess atrial fibrillation prevalence. For atrial fibrillation incidence assessment, 1059 (81% of original sample) Tsimane and 310 Moseten (58%) underwent additional ECGs (mean time to follow up 7.0, 1.8 years, respectively).Findings:Only one (male) of 1314 Tsimane (0.076%) and one (male) of 534 Moseten (0.187%) demonstrated atrial fibrillation at baseline. There was one new (female) Tsimane case in 7395 risk years for the 1059 participants with >1 ECG (incidence rate = 0.14 per 1,000 risk years). No new cases were detected among Moseten, based on 542 risk years.Conclusion: Tsimane and Moseten show the lowest levels of atrial fibrillation ever reported, 1/20 to ~1/6 of rates in high-income countries. These findings provide additional evidence that a subsistence lifestyle with high levels of physical activity, and a diet low in processed carbohydrates and fat is cardioprotective, despite frequent infection-induced inflammation. Findings suggest that atrial fibrillation is a modifiable lifestyle disease rather than an inevitable feature of cardiovascular aging. Published on 2021-02-16 12:57:33
Abstract: Member States at this year’s World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a crosscutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities. Published on 2021-02-15 11:48:48
Abstract: Background: Measuring national progress towards the Sustainable Development Goals (SDGs) enables the identification of gaps which need to be filled to end poverty, protect the planet and improve lives. Progress is typically calculated using indicators stemming from published methodologies. South Africa tracks progress towards the SDGs at a national scale, but aggregated data may mask progress, or lack thereof, at local levels.Objective: To assess the progress towards achievement of the SDGs in four low-income, rural villages (Giyani) in South Africa and to relate the findings to national SDG indicators.Methods: Using data from a cross-sectional environmental health study, the global indicator framework for the SDGs was applied to calculate indicators for Giyani. Local progress towards SDG achievement was compared with national progress, to contextualize and supplement national scale tracking.Findings: Village scores were mostly in line with country scores for those indices which were computable, given the available data. Low data availability prevented a complete local progress assessment. Higher levels of poverty prevail in the study villages compared to South Africa as a whole (17.7% compared to 7.4%), high unemployment (49.0% compared to 27.3%) and lack of access to information via the Internet (only 4.2% compared to 61.8%) were indicators in the villages identified as falling far short of the South African averages.Conclusions: Understanding progress towards the SDGs at a local scale is important when trying to unpack national progress. It shines a light upon issues that are not picked up by national composite assessments yet require most urgent attention. Gaps in data required to measure progress towards targets represents a serious stumbling block, preventing the creation of a true reflection of local and national scale progress. Published on 2021-02-15 11:45:22
Abstract: Background: Trauma is a major global health problem and majority of the deaths occur in low- and middle-income countries (LMICs), at even higher rates in the rural areas. The three-delay model assesses three different delays in accessing healthcare and can be applied to improve surgical and trauma healthcare delivery. Prior to implementing change, the capacities of the rural India healthcare system need to be identified.Objective: The object of this study was to estimate surgical and trauma care capacities of government health facilities in rural Nanakpur, Haryana, India using the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT) tools.Methods: The PIPES and INTACT tools were administered at eight government health facilities serving the population of Nanakpur in June 2015. Data analysis was performed per tool subsection, and an overall score was calculated. Higher PIPES or INTACT indices correspond to greater surgical or trauma care capacity, respectively.Findings: Surgical and trauma care capacities increased with higher levels of care. The median PIPES score was significantly higher for tertiary facilities than primary and secondary facilities [13.8 (IQR 9.5, 18.2) vs. 4.7 (IQR 3.9, 6.2), p = 0.03]. The lower-level facilities were mainly lacking in personnel and procedures.Conclusions: Surgical and trauma care capacities at healthcare facilities in Haryana, India demonstrate a shortage of surgical resources at lower-level centers. Specifically, the Primary Health Centers were not operating at full capacity. These results can inform resource allocation, including increasing education, across different facility levels in rural India. Published on 2021-02-12 08:38:15
Abstract: Background: Estimates region-related prevalence of hypertension and attempts to identify its related factors at the district levels are required for prevention and management of hypertension.Objective: The aim of this study was to investigate the epidemic features and related factors of hypertension and its awareness, treatment, and control rates among the northern Iranian population.Methods: It was a community based cross-sectional study based on data from PERSIAN Guilan Cohort Study (PGCS). In total, 10,520 participants (aged 35–70 years) from the Guilan Province in northern Iran included in this study, between October 8, 2014, and January 20, 2017. Hypertension was defined as systolic blood pressure =140 mmHg or diastolic blood pressure =90 mmHg or a prior diagnosis of hypertension or being on antihypertensive medication. Potential correlates of hypertension and its awareness, treatment and control were analyzed by multivariate logistic regression adjusted for demographic factors, anthropometric characteristics, lifestyle variables, past medical history, and laboratory data.Results: The prevalence of hypertension was 43.2% and the hypertension awareness, treatment, and control rate were 53.4%, 49.8%, and 73.7%, respectively. The multivariate logistic regression analyses revealed that older age, urbanization, lower education, overweight and obesity, lower physical activity, prediabetes and diabetes, cardiovascular disease, psychiatric disorder, positive family history of hypertension and raised serum creatinine were independently associated with presence of hypertension. Awareness of hypertension was greater in the female sex, older age, rural residency, higher education and patient with comorbidities. Older age, rural residency and comorbidities were associated with treatment of hypertension. Control of hypertension was better among younger age, higher education, normal weight and higher physical activity.Conclusion: Hypertension is highly prevalent in the northern Iranian population. About half of affected persons are unaware of their disease and untreated. Modifying risk factors (such as weight lose and increase physical activity) and increasing hypertension awareness (by screening) is essential for primary and secondary prevention of high blood pressure in this population, especially in urban areas and among males, younger ages, and less educated. Published on 2021-02-12 08:25:23
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