Comparative assessment of the prevalence, practices and factors associated with self-medication with antibiotics in Africa.

OBJECTIVE: To evaluate and compare the prevalence, reasons, sources and factors associated with self-medication with antibiotics (SMA) within Africa. METHODS: Systematic review and meta-analysis. An electronic search of PubMed and Google Scholar databases was performed for observational studies conducted between January 2005 and February 2020. Two reviewers independently screened abstracts and full texts using the PRISMA flowchart and performed quality assessment of eligible studies. Both qualitative and quantitative syntheses were carried out. RESULTS: Forty studies from 19 countries were eligible for qualitative synthesis. The prevalence of SMA in Africa ranged from 12.1% to 93.9% with a median prevalence of 55.7% (IQR 41-75%). Western Africa was the sub-region with the highest reported prevalence of 70.1% (IQR 48.3-82.1%), followed by Northern Africa with 48.1% (IQR 41.1-64.3%). We identified 27 antibiotics used for self-medication from 13 different antibiotic classes. Most frequently used antibiotics were penicillins (31 studies), tetracyclines (25 studies) and fluoroquinolones (23 studies). 41% of these antibiotics belong to the WHO Watch Group. The most frequent indications for SMA were upper respiratory tract infections (27 studies), gastrointestinal tract symptoms (25 studies) and febrile illnesses (18 studies). Common sources of antibiotics used for self-medication were community pharmacies (31 studies), family/friends (20 studies), leftover antibiotics (19 studies) and patent medicine stores (18 studies). The most frequently reported factor associated with SMA was no education/low educational status (nine studies). CONCLUSIONS: The prevalence of SMA is high in Africa and varies across sub-regions with the highest prevalence reported in Western Africa. Drivers of SMA are complex, comprising of socio-economic factors and insufficient access to health care coupled with poorly implemented policies regulating antibiotic sales.

Successful management of an advanced interstitial ectopic pregnancy in a resource-limited setting: a case report.

BACKGROUND: Interstitial ectopic pregnancy is an ectopic gestation developing in the uterine part of the fallopian tube. The condition is rare and presents challenges for clinical as well as radiological diagnosis. This case report presents a rare case of interstitial ectopic pregnancy diagnosed intraoperatively. CASE PRESENTATION: A 36-year-old Black woman, referred from a peripheral health facility, presented at the emergency department with severe abdominal pains, vaginal spotting, nausea, and vomiting, with a 2-month history of irregular menstrual flow. Clinical and laboratory findings were suggestive of an acute abdomen likely due to a ruptured ectopic pregnancy (ultrasound was not available). An emergency exploratory laparotomy was done, which revealed a right adnexal ruptured interstitial pregnancy of a lifeless female fetus weighing 500 g (estimated mean gestational age of 22-23 weeks). The left fallopian tube looked normal. The site of rupture was repaired, followed by cleaning and closure of the abdomen. The post-operative period was uneventful, and the patient was discharged on postoperative day 7. CONCLUSION: Interstitial pregnancies are uncommon and rarely attain advanced gestational ages, as in this case, compared with other tubal ectopic pregnancies. However, women presenting with signs of hypovolemic shock and acute abdomen, with a positive pregnancy test, warrant a high index of suspicion.

Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance.

INTRODUCTION: Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED: A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION: ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.

Marburg virus disease outbreak in Guinea: a SPIN framework of its transmission and control measures for an exemplary response pattern in West Africa.

Responding to highly infectious diseases relies on a thorough understanding of transmission epidemiology. With the recent outbreak of Marburg Virus Disease (MVD) in Guinea, we saw the need to shed some technical light based on published literature and our field experiences. We reviewed 14 previous MVD outbreaks globally. Coupled with core one - health approaches, we propose a Socio-environmental context, Possible transmission routes, Informing and guiding public health action, Needs in terms of control measures (SPIN) framework as a guiding tool for response teams to appropriately approach future infectious disease outbreaks.

COVID-19 pandemic: implementing control measures in Africa using the 'SHEF2' model.

The COVID-19 Pandemic in Africa is a severe reminder of the brunt of emerging and re-emerging infectious pathogens and the need for simple, context-oriented, and sustainable health models to combat them when the need arises. In this commentary, an analytical discursive approach was chosen to owe to Africa's unique situation of weak health systems, with most of its member states showing an initial reluctance to deal openly with the COVID-19 situation. This paper discusses five major control measures doped the SHEF2 Model i.e. ("SHEF2"- S: Social distancing, H: Hands, E: Elbows, F: Face, F: Feel) of COVID-19 implemented in Africa. We also review the issues related to implementing SHEF2 control measures in Africa. The measures being taken in Asia, Europe, and North America such as social distancing and regular hand washing are a particular challenge for African countries with dense populations, unequal access to water, and limited social safety nets. COVID-19 is challenging the public health and socio-political systems of all affected African countries. The burden of COVID-19 demands rapid and decisive action to be taken, yet the comparison shows how difficult it is was for an unknown new coronavirus disease. In line with the steps being taken across the globe to control and contain COVID-19 pandemic, African countries are preparing for the great effects of this pandemic and ensuing deep recession thus the reason we assert, the greater hope for African countries is implementing an aggressive SHEF2 model strategy. The spread of the pandemic will eventually stop, and the international system will find a balance, but most of the damage will be felt particularly by Africa.

Trends and patterns of family planning methods used among women attending family planning clinic in a rural setting in sub-Sahara Africa: the case of Mbalmayo District Hospital, Cameroon.

OBJECTIVE: Family planning enables women to prevent unwanted pregnancies and control family sizes. Provision of family planning services is an essential human right. This study aimed to describe the trends and patterns of contraceptive use in a family planning clinic in a rural district hospital setting. RESULTS: A total 313 participants who used contraceptives between March 2016 and August 2017 were included this study given a. Their mean age was 32.4 ± 1.8 years with an age range of 18-48 years. The index study estimates the rate of contraceptive use at 17.4 contraceptives per month. The most commonly used contraceptive methods were implants and IUD in 29.4 and 28.4% of the participants respectively while the least used was condoms in 8.3% of the participants. Contraceptive used are highest among those 21-40 years (83.1%) and least among adolescents less than 20 years (6.7%).

Multidrug resistant Proteus mirabilis and Escherichia coli causing fulminant necrotising fasciitis: a case report.

BACKGROUND: Necrotizing fasciitis is a rare soft tissue infection characterized by rapid progressive necrosis with relative sparing of underlying muscles. This case is reported to highlight the emergence of multidrug resistant microbes in recent days which limits the use of empiric antibiotic therapy and necessitates early cultures and sensitivity enabling targeted antibiotic therapy. Factors that lead to antimicrobial resistance especially in sub-Saharan Africa have also been discussed. CASE PRESENTATION: We report the case of a 52-year-old black man who was referred to our centre for the management of cellulitis and suppurating ulcers of the right leg which had progressed to a wet gangrene. Following physical examination and work-up, a diagnosis of fulminant necrotizing fasciitis of the right leg caused by multidrug resistant Proteus mirabilis and Escherichia coli was made. Despite the broad-spectrum empiric antibiotic therapy and aggressive multiple surgical debridement, necrosis progressed leading to an above-knee amputation. CONCLUSION: Necrotizing fasciitis is a surgical emergency that requires prompt diagnosis and aggressive surgical debridement in order to reduce morbidity and mortality. The emergence of multidrug resistant organisms in recent days have limited the use of empiric antibiotic therapy, necessitating early culture and sensitivity and the use of susceptibility-guided antibiotic therapy. Timely action to control the use of antibiotics in sub-Saharan Africa will reduce multidrug resistance and delay the arrival of post-antibiotics era.

Giant ovarian cyst masquerading as a massive ascites: a case report.

BACKGROUND: Giant ovarian cysts are tumours of the ovary presenting with diameters greater than 10 cm. Giant ovarian cysts have become rare in recent days as they are diagnosed and managed early due to the availability of good imaging modalities. The aim of this case report is to show how a huge cystic ovarian mass can mislead the diagnosis of ascites in a postmenopausal woman. Factors associated with late presentation of giant ovarian cysts in sub-Saharan Africa have also been discussed. CASE PRESENTATION: We present the case of a 65-year-old grand multiparous woman who was referred to our centre with a grossly distended abdomen misdiagnosed as a massive ascites. Abdominopelvic ultrasound scan revealed a right giant multiloculated ovarian cyst. She benefited from a cystectomy with an uneventful postoperative stay. Histopathology revealed mucinous cystadenoma. CONCLUSION: Large cystic ovarian tumours can present masquerading as massive ascites and misleading diagnosis as in this case report. We report this case to increase the suspicion index of a large ovarian cyst in all women presenting with massive ascites.

Ten years analysis of stillbirth in a tertiary hospital in sub-Sahara Africa: a case control study.

OBJECTIVE: Stillbirth measures provide means to assess adequacy of maternal and perinatal care in a given population. The aim of this study was to describe the determinants of stillbirth in Douala general hospital, Cameroon. RESULTS: Determinants of stillbirth in this hospital are: maternal age ≥35 years (OR 1.79, 95% CI 1.26-2.54, p = 0.001), pre-eclampsia/eclampsia (OR 2.97, 95% CI 0.87-8.89, p value of 0.03), diabetes in pregnancy (OR 9.97, 95% CI 1.15-86.86, p = 0.03), stillbirth in previous pregnancies (OR 3.94, CI 2.02-7.7, p < 0.0001), inter-pregnancy interval >2 years (OR 2, 06 CI 1.22-3.49; p = 0,006), referral from another hospital (OR 14.16, 95% CI 7.08-28.3, p < 0.0001), gestational age <37 (OR 19.9, 95% CI 12.3-32.2, p < 0.0001) and >42 (OR 6.27, 95% CI = 0.86-45.2, p = 0.096), congenital malformation (OR 11.09, 95% CI 3.2-38,5, p < 0.0001) and birth weight <2500 g (p < 0.0001).

Tropical diabetic hand syndrome: a case report.

BACKGROUND: Tropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis. CASE PRESENTATION: We report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis. CONCLUSION: Though tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.