ABSTRACT
Four family physicians, who received their specialty training at Amoud University in Somaliland, organised a practice together that uses informal public-private partnerships to optimise their clinical care and teaching. Their experience offers insights into public-private partnerships that could strengthen the country's healthcare system.
Subject(s)
Family Practice , Private Sector , Delivery of Health Care , Humans , Public-Private Sector PartnershipsABSTRACT
Somaliland's first specialty training programme for physicians was a master's degree in Family Medicine that began at Amoud University in 2012. A survey of the 24 Family Medicine graduates working in Somaliland demonstrates their clinical and leadership impact on the health system and their contribution to higher education. The specialists directly contribute to the health and education priorities of the government of Somaliland.
Subject(s)
Family Practice , Physicians , Family Practice/education , Humans , Leadership , Specialization , UniversitiesABSTRACT
BACKGROUND: Khat chewing is common especially among men in East Africa and Yemen. It is generally viewed by the populace as a benign social custom. Several studies of ethnic Somali immigrants to Western countries suggest an association between khat chewing and hepatotoxicity, but the risk of hepatotoxicity related to khat chewing within African settings is not documented. AIM: To identify and describe liver disease without evidence of alcohol exposure or infectious etiology in khat chewers. SETTINGS: A university-affiliated teaching hospital in Somaliland. METHODS: Cases of cirrhosis of unknown cause were identified from the clinical practice of Al Hayatt Hospital in Borama, Somaliland, during 14 months beginning December 2012. RESULTS: Eight Somali men aged 27-70 years living in Somaliland were identified with cirrhosis of otherwise unknown cause. All chewed khat habitually for many years (15-128 bundles per day times years of use). A liver biopsy of one man was consistent with khat hepatotoxicity. Four of the eight men died during the study period. CONCLUSION: Khat chewing may be associated with health consequences including severe hepatotoxicity with cirrhosis.
Subject(s)
Catha/adverse effects , Liver Cirrhosis/etiology , Adult , Aged , Biopsy , Djibouti/epidemiology , Humans , Liver/pathology , Liver Cirrhosis/epidemiology , Liver Cirrhosis/pathology , Male , Middle AgedABSTRACT
OBJECTIVES: The purpose of this study is to amplify the knowledge base of the epidemiology, symptoms, and signs of extrapulmonary tuberculosis (EPTB) in Afghanistan. METHODS: This is a retrospective review of EPTB diagnosed at CURE International Hospital and CURE Family Health Center (FHC) in Kabul, Afghanistan during a recent 20-month period. RESULTS: One hundred eighteen cases were identified from patients presenting to the hospital and FHC. This group represents the spectrum of EPTB seen at a single referral center in Kabul. The ratio of females to males was 2.03:1. Lymph node tuberculosis comprised the greatest number of EPTB cases (37.3%, n=44). The central nervous system was the next most frequent site of EPTB involvement (20.3%, n=24), followed in descending order by skeletal, pleural, abdominal, cutaneous, genitourinary, pericardial, miliary, and breast tuberculosis. CONCLUSIONS: The 2:1 ratio of female to male EPTB cases coincides with the unusual epidemiologic pattern seen in smear-positive pulmonary TB in Afghanistan. As the first epidemiological report of EPTB from Afghanistan, this study illustrates the varied presentations of EPTB that should be known by healthcare workers throughout the country.