African Medical Educators and Anatomy Teachers' Perceptions and Acceptance of the Anatomage Table as an EdTech and Innovation: A Qualitative Study.

Background: This article presents a qualitative study of African anatomists and anatomy teachers on the Anatomage Table-a modern medical education technology and innovation, as an indicator of African anatomy medical and anatomy educators' acceptance of EdTech. The Anatomage Table is used for digital dissection, prosection, functional anatomy demonstration, virtual simulation of certain functions, and interactive digital teaching aid. Materials and Methods: Anatomy teachers [n=79] from 11 representative African countries, Ghana, Nigeria [West Africa], Ethiopia, Kenya, Rwanda [East Africa], Namibia [South Africa], Zambia [Southern Africa], Egypt [North Africa], and Sudan [Central Africa], participated in this study. Focus group discussions [FGDs] were set up to obtain qualitative information from stakeholders from representative institutions. In addition, based on the set criteria, selected education leaders and stakeholders in representative institutions participated in In-depth Interviews [IDIs]. The interview explored critical issues concerning their perceptions about the acceptance, adoption, and integration of educational technology, specifically, the Anatomage Table into the teaching of Anatomy and related medical sciences in the African continent. Recorded interviews were transcribed and analyzed using the Dedoose software. Results: African anatomists are generally technology inclined and in favor of EdTech. The most recurring opinion was that the Anatomage Table could only be a "complementary teaching tool to cadavers" and that it "can't replace the real-life experience of cadavers." Particularly, respondents from user institutions opined that it "complements the traditional cadaver-based approaches" to anatomy learning and inquiry, including being a good "complement for cadaveric skill lab" sessions. Compared with the traditional cadaveric dissections a majority also considered it less problematic regarding cultural acceptability and health and safety-related concerns. The lifelikeness of the 3D representation is a major factor that drives acceptability.

A Study of Anatomy Teachers' Perception and Acceptance of the Anatomage Table Technology and Digital Teaching Materials in the Training of Medical and Allied Health Students.

BACKGROUND: The Anatomage Table is a modern technology that is used to enhance the teaching of human anatomy and related basic medical sciences to medical and allied health students. Its use is gaining popularity. This study considered anatomy teachers' perception and acceptance of the Anatomage Table technology and digital teaching materials in the training of medical and allied health students in African countries. MATERIALS AND METHODS: Validated questionnaires were used. Altogether, 79 respondents fully participated in the study, with all African regions being represented as follows: Ghana, Nigeria (West Africa), Ethiopia Kenya Rwanda (East Africa), Namibia, South Africa, Zambia (Southern Africa), Egypt (North Africa), and Sudan (Central Africa). Responses were obtained from the electronic Google form, organized on Excel spreadsheets, and analyzed using the SPSS statistical software version 23.0 (IBM Corp, Armonk, NY). RESULTS: In terms of proportion, 29.1% of respondents reported that they had some level of mastery in using the Anatomage Table; with 6.3% of all the participants reportedly having a high mastery of this technology, 12% and 6% reported that they had an average mastery and low mastery levels, respectively. Participants' rating of their level of agreement with whether the Anatomage Table is a useful EdTech showed that 54.4% of them strongly agreed while 27.8% just agreed. The majority considered the use of the Anatomage as a means of embracing the global culture of technology-in-medical sciences (87.3%). CONCLUSION: Most respondents would accept the technology as a complementary tool to support the existing traditional practices, especially cadaveric.

Characteristics of Genitourinary Fistula in Kigali, Rwanda; 5-Year Trends.

OBJECTIVE: To assess the characteristics of women presenting with genitourinary fistula over a 5-year period in Kigali, Rwanda. Genitourinary (GU) fistula is a devastating condition that can result from difficult vaginal deliveries or as a surgical complication. Rwanda has seen notable increases in cesarean section rates as a result of a successful universal health care system. It is unclear how the increase in cesarean section rates may influence the types of fistula diagnosed. MATERIALS AND METHODS: A cross-sectional study was conducted of women presenting for evaluation to the International Organization for Women and Development in Kigali, Rwanda, between February 1, 2013 and October 31, 2017. Data were collected from medical records, including demographics, surgical history, physical exam findings, and surgical intervention. RESULTS: Two thousand ninety-one women presented for evaluation during the study period, of these 630 (30%) were diagnosed with GU fistula. Of the fistula diagnosed, 392 (62%) were vesicovaginal fistula, 185 (29%) were vesicouterine or vesicocervical, and 56 (9%) were ureterovaginal fistula. The percent of GU fistula that involved the ureter, uterus, and/or cervix significantly increased over the time period: 29.6% in 2013, 34.6% in 2014; 43.0% in 2015, 42.9% in 2016, and 45.3% in 2017. CONCLUSION: There was a significant increase in the proportion of vesicouterine, vesicocervical, and ureterovaginal fistula presenting in Rwanda over the 5-year period, with the majority occurring after cesarean section.

Obstetric Fistula Repair in Sub-Saharan Africa: Partnering to Create Sustainable Impact for Patients and Trainees.

Obstetric fistula, an abnormal connection between a woman's genital tract and urinary tract or rectum, can be physically and psychosocially debilitating. We describe a sustainable obstetric fistula surgical trip model that includes providers from Women and Infants Hospital at Brown University. These surgical trips provide pre-operative, surgical, and post-operative care to patients with fistulae at Kibagabaga Hospital in Kigali, Rwanda. To ensure patients are prepared for the recovery process after fistula surgery, the team created a post-operative education curriculum that includes illustrative visual aids and teaching guides translated into Kinyarwanda, focusing on topics including urinary catheter care, wound care, and pain management. Through this program, the team is committed to restoring women's dignity through fistula repair as well as providing a model for delivery of sustainable surgical care in low-resource settings. Involvement of trainees into a global health team like this can benefit both the trainee and the patients served.

A One Health systematic review of diagnostic tools for Echinococcus multilocularis surveillance: Towards equity in global detection.

Echinococcus multilocularis is a zoonotic cestode of canid definitive hosts that is emerging as a parasite of medical and veterinary concern in regions of North America, Europe and Asia. Infection with the metacestode stage (alveolar echinococcosis - AE) is life-threatening, especially for patients who reside in low resource countries and lack access to modern diagnostic tests and treatments. The overall objectives of this One Health review were to systematically describe the diagnostic tests currently employed in endemic countries to detect E. multilocularis in people, canids and the environment, and to report the test characteristics of new diagnostic techniques for population surveillance. In this systematic review of English and Chinese language databases, we identified 92 primary records of E. multilocularis surveillance in canids (N = 75), humans (N = 20) and/or the environment (food, soil; N = 3) and 12 grey literature records that reported E. multilocularis surveillance or health systems protocols between 2008 and 2018. Surveillance for E. multilocularis was conducted using a broad range of combined morphological, molecular, immunological and imaging techniques. Nine studies reporting diagnostic evaluations for cestode or metacestode detection were identified, including studies on copro-antigen ELISA, copro-PCR, intestinal examination, Western Blot, magnetic capture RT-PCR and immunochromatography. Our dataset includes prevalence estimates for E. multilocularis in canids, people, or environment in 27 of the 43 endemic countries and reports data gaps in surveillance, laboratory methods, and diagnostic sensitivity. International consensus on gold standard diagnostic techniques and harmonization of human, canid and environmental surveillance data across political boundaries are needed to comprehensively assess the global burden and distribution of this parasite.

Giving Voice to the Experiences of Rwandan Women With Urogenital Fistula.

BACKGROUND: Urogenital fistula is a debilitating condition that women can develop following obstructed labor. The primary objective of this study was to reveal illness narratives of Rwandan women with urogenital fistula to appreciate their unique experiences. The secondary aim was to identify common themes that emerged when women discussed their experiences living with fistula. METHODS: Women presenting for urogenital fistula repair at Kibagabaga Hospital were asked to participate in the study. Eleven participants were asked questions designed to elicit their understanding of their condition and the social and emotional consequences of their fistula. All interviews were anonymous. Transcribed interviews were examined for relative themes to categorize responses into larger domains. FINDINGS: Common themes were identified from the interviews on topics of what barriers existed to having a successful delivery, the socioeconomic and psychosocial consequences of developing a fistula, and each woman's understanding of her fistula. Excerpts from patients' illness narratives illustrated these themes. CONCLUSIONS: These narratives can be used to appreciate the variations in each woman's understanding of her medical condition and the changes that occurred in her life as a result of her fistula. Through patients' narratives, physicians can improve their appreciation of cultural differences to design targeted educational and preventive interventions.