Paving the Path to Patient-Centered Healthcare in Africa: Insights From a Student Led Initiative.

Patient-centered care (PCC) is a key domain of healthcare quality. Its importance is driven by evidence-based medicine, the predominance of chronic conditions requiring self-care, and the recognition of the priority of patient goals, values, priorities, and preferences in determining care plans. This article emphasizes the urgent need for Africa to develop PCC and a workforce committed to its implementation, as well as highlights an initiative by African medical students to champion PCC continent-wide. Embracing this transformative approach presents Africa with an unprecedented opportunity to improve care for each person. Through a comprehensive exploration of unique strategies and considerations in African health professions education, this viewpoint seeks to spark dialogue and inspire action towards a future where patient-centered care is the foundation of healthcare delivery in Africa.

Ancient mitogenomes from Pre-Pottery Neolithic Central Anatolia and the effects of a Late Neolithic bottleneck in sheep (Ovis aries).

Occupied between ~10,300 and 9300 years ago, the Pre-Pottery Neolithic site of Asikli Höyük in Central Anatolia went through early phases of sheep domestication. Analysis of 629 mitochondrial genomes from this and numerous sites in Anatolia, southwest Asia, Europe, and Africa produced a phylogenetic tree with excessive coalescences (nodes) around the Neolithic, a potential signature of a domestication bottleneck. This is consistent with archeological evidence of sheep management at Asikli Höyük which transitioned from residential stabling to open pasturing over a millennium of site occupation. However, unexpectedly, we detected high genetic diversity throughout Asikli Höyük's occupation rather than a bottleneck. Instead, we detected a tenfold demographic bottleneck later in the Neolithic, which caused the fixation of mitochondrial haplogroup B in southwestern Anatolia. The mitochondrial genetic makeup that emerged was carried from the core region of early Neolithic sheep management into Europe and dominates the matrilineal diversity of both its ancient and the billion-strong modern sheep populations.

Contagion to unrest: Investigating the link between disease and civil unrest in Africa.

Scholars, policymakers, and citizens alike remain invested in the impact of infectious diseases worldwide. Studies have found that emerging diseases and disease outbreaks burden global economies and public health goals. This article explores the potential link between measles outbreaks and various forms of civil unrest, such as demonstrations, riots, strikes, and other anti-government violence, in four central African countries from 1996 to 2005. Using a difference-in-differences model, we examine whether disease outbreaks have a discernible impact on the prevalence of civil unrest. While our findings indicate that the relationship between disease and civil unrest is not as strong as previously suggested, we identify a notable trend that warrants further investigation. These results have significant implications for health and policy officials in understanding the complex interplay between state fragility, civil unrest, and the spread of disease.

Breast cysticercosis - a case report.

SUMMARY: Isolated incidences of human cysticercosis have been reported world-wide, but it remains a major public health concern in endemic areas such as Mexico, Africa, South-East Asia, Eastern Europe, and South America. Cysticercosis most commonly involves the skeletal muscle, subcutaneous tissue, brain, and eyes. The breast is an uncommon site of presentation for cysticercosis. Due to its rare occurrence, breast cysticercosis is often initially mistaken for other common breast lesions such as cysts, abscess, malignant tumours and fibroadenomas. We report a case of breast cysticercosis in a young South African woman.

Post-traumatic stress disorder and associated factors among internally displaced persons in Africa: A systematic review and meta-analysis.

BACKGROUND: Internally displaced people (IDPs), uprooted by conflict, violence, or disaster, struggle with the trauma of violence, loss, and displacement, making them significantly more vulnerable to post-traumatic stress disorder (PTSD). Therefore, we conducted a systematic review and meta-analysis to assess the prevalence and associated factors of PTSD among IDPs in Africa. METHODS: A comprehensive search of electronic databases was conducted to identify relevant studies published between 2008 and 2023. The search included electronic databases such as PubMed, CABI, EMBASE, SCOPUS, CINHAL, and AJOL, as well as other search sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted using Microsoft Excel, and analysis was performed using STATA 17 software. The quality of the included studies was assessed using the JBI quality appraisal tool. A random-effects model was used to estimate the pooled prevalence of PTSD and its associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics was used to assess heterogeneity. The protocol for this review has been registered with PROSPERO (ID: CRD42023428027). RESULTS: A total of 14 studies with a total of 7,590 participants met the inclusion criteria. The pooled prevalence of PTSD among IDPs in Africa was 51% (95% CI: 38.-64). Female gender (OR = 1.99, 95% CI: 1.65-2.32), no longer married (OR = 1.93, 95% CI: 1.43-2.43), unemployment (OR = 1.92, 95% CI: 1.17-2.67), being injured (OR = 1.94, 95% CI: 1.50-1.50), number of traumatic events experienced [4-7(OR = 2.09, 95% CI: 1.16-3.01), 8-11 (OR = 2.09, 95% CI: 2.18-4.12), 12-16 (OR = 5.37, 95% CI: 2.61-8.12)], illness without medical care (OR = 1.92, 95% CI: 1.41-2.29), being depressed (OR = 2.97, 95% CI: 2.07-3.86), and frequency of displacement more than once (OR = 2.13, 95% CI: 1.41-2.85) were significantly associated with an increased risk of PTSD. CONCLUSIONS: The findings of this systematic review and meta-analysis highlight the alarming prevalence of PTSD among IDPs in Africa. Female gender, marital status, number of traumatic events, ill health without medical care, depression, and frequency of displacement were identified as significant risk factors for PTSD. Effective interventions and the development of tailored mental health programs are needed to prevent PTSD among IDPs, focusing on the identified risk factors.

Lessons from CanSpotASF: Moving towards risk-based African Swine Fever surveillance with rule-out testing in Western Canada.

African swine fewer (ASF) is a serious disease present in Africa, Eurasia, and the Caribbean but not in continental North America. CanSpotASF describes the ASF surveillance in Canada as a phased in approach. The first enhancement to the passive surveillance was the risk-based early detection testing (rule-out testing) where eligible cases were tested for ASF virus (ASFv). The objective was to describe how the eligibility criteria were applied to cases in western Canada. In particular, to assess if cases tested for ASFv had eligible conditions and if pathology cases with eligible conditions were tested for ASFv based on the data collated by Canada West Swine Health Intelligence Network (CWSHIN) from British Columbia, Alberta, Saskatchewan, and Manitoba. The study period was August 2020 to December 2022 and the data included two study laboratories. We found that over 90% of cases tested for ASFv had eligible conditions as defined in CanSpotASF. The eligibility criteria were applied at three stages of the disease investigation process: 1) the clinical presentation in the herd; 2) at the initial laboratory assessment; and 3) the final pathology diagnosis. At the two study laboratories the proportion of all submitted cases (culture, serology, PCR, pathology) tested for ASFv was very low 1%. However, in the pathology cases specifically targeted in CanSpotASF, and the proportion of tested cases was 12%. In addition, for eligible pathology cases (eligible diagnosis or test) the proportion tested was higher 15%. These results indicated that CanSpotASF targeted herds with submissions for pathological examination and to some degree eligible conditions which would be herds with health issues (known or unknown). We interpret this as a first step towards risk-based surveillance with health as the defining factor.

Greater Disease Severity and Worse Clinical Outcomes in Patients Hospitalised with COVID-19 in Africa.

Background: COVID-19 cardiovascular research from Africa is limited. This study describes cardiovascular risk factors, manifestations, and outcomes of patients hospitalised with COVID-19 in the African region, with an overarching goal to investigate whether important differences exist between African and other populations, which may inform health policies. Methods: A multinational prospective cohort study was conducted on adults hospitalised with confirmed COVID-19, consecutively admitted to 40 hospitals across 23 countries, 6 of which were African countries. Of the 5,313 participants enrolled globally, 948 were from African sites (n = 9). Data on demographics, pre-existing conditions, clinical outcomes in hospital (major adverse cardiovascular events (MACE), renal failure, neurological events, pulmonary outcomes, and death), 30-day vitality status and re-hospitalization were assessed, comparing African to non-African participants. Results: Access to specialist care at African sites was significantly lower than the global average (71% vs. 95%), as were ICU admissions (19.4% vs. 34.0%) and COVID-19 vaccination rates (0.6% vs. 7.4%). The African cohort was slightly younger than the non-African cohort (55.0 vs. 57.5 years), with higher rates of hypertension (48.8% vs. 46.9%), HIV (5.9% vs. 0.3%), and Tuberculosis (3.6% vs. 0.3%). In African sites, a higher proportion of patients suffered cardiac arrest (7.5% vs. 5.1%) and acute kidney injury (12.7% vs. 7.2%), with acute kidney injury (AKI) appearing to be one of the strongest predictors of MACE and death in African populations compared to other populations. The overall mortality rate was significantly higher among African participants (18.2% vs. 14.2%). Conclusions: Overall, hospitalised African patients with COVID-19 had a higher mortality despite a lower mean age, contradicting literature that had previously reported a lower mortality attributed to COVID-19 in Africa. African sites had lower COVID-19 vaccination rates and higher AKI rates, which were positively associated with increased mortality. In conclusion, African patients were hospitalized with more severe COVID-19 cases and had poorer outcomes.

Politics-evidence conflict in national health policy making in Africa: a scoping review.

BACKGROUND: Generally, public health policy-making is hardly a linear process and is characterized by interactions among politicians, institutions, researchers, technocrats and practitioners from diverse fields, as well as brokers, interest groups, financiers and a gamut of other actors. Meanwhile, most public health policies and systems in Africa appear to be built loosely on technical and scientific evidence, but with high political systems and ideologies. While studies on national health policies in Africa are growing, there seems to be inadequate evidence mapping on common themes and concepts across existing literature. PURPOSE: The study seeks to explore the extent and type of evidence that exist on the conflict between politics and scientific evidence in the national health policy-making processes in Africa. METHODS: A thorough literature search was done in PubMed, Cochrane Library, ScienceDirect, Dimensions, Taylor and Francis, Chicago Journals, Emerald Insight, JSTOR and Google Scholar. In total, 43 peer-reviewed articles were eligible and used for this review. RESULT: We found that the conflicts to evidence usage in policy-making include competing interests and lack of commitment; global policy goals, interest/influence, power imbalance and funding, morals; and evidence-based approaches, self-sufficiency, collaboration among actors, policy priorities and existing structures. Barriers to the health policy process include fragmentation among actors, poor advocacy, lack of clarity on the agenda, inadequate evidence, inadequate consultation and corruption. The impact of the politics-evidence conflict includes policy agenda abrogation, suboptimal policy development success and policy implementation inadequacies. CONCLUSIONS: We report that political interests in most cases influence policy-makers and other stakeholders to prioritize financial gains over the use of research evidence to policy goals and targets. This situation has the tendency for inadequate health policies with poor implementation gaps. Addressing these issues requires incorporating relevant evidence into health policies, making strong leadership, effective governance and a commitment to public health.

Multisectoral interventions for urban health in Africa: a mixed-methods systematic review.

Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world's fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989-2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet.Paper ContextMain findings: Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental.Added knowledge: We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings.Global health impact for policy and action: This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.

The effect of explicit convection on simulated malaria transmission across Africa.

Malaria transmission across sub-Saharan Africa is sensitive to rainfall and temperature. Whilst different malaria modelling techniques and climate simulations have been used to predict malaria transmission risk, most of these studies use coarse-resolution climate models. In these models convection, atmospheric vertical motion driven by instability gradients and responsible for heavy rainfall, is parameterised. Over the past decade enhanced computational capabilities have enabled the simulation of high-resolution continental-scale climates with an explicit representation of convection. In this study we use two malaria models, the Liverpool Malaria Model (LMM) and Vector-Borne Disease Community Model of the International Centre for Theoretical Physics (VECTRI), to investigate the effect of explicitly representing convection on simulated malaria transmission. The concluded impact of explicitly representing convection on simulated malaria transmission depends on the chosen malaria model and local climatic conditions. For instance, in the East African highlands, cooler temperatures when explicitly representing convection decreases LMM-predicted malaria transmission risk by approximately 55%, but has a negligible effect in VECTRI simulations. Even though explicitly representing convection improves rainfall characteristics, concluding that explicit convection improves simulated malaria transmission depends on the chosen metric and malaria model. For example, whilst we conclude improvements of 45% and 23% in root mean squared differences of the annual-mean reproduction number and entomological inoculation rate for VECTRI and the LMM respectively, bias-correcting mean climate conditions minimises these improvements. The projected impact of anthropogenic climate change on malaria incidence is also sensitive to the chosen malaria model and representation of convection. The LMM is relatively insensitive to future changes in precipitation intensity, whilst VECTRI predicts increased risk across the Sahel due to enhanced rainfall. We postulate that VECTRI's enhanced sensitivity to precipitation changes compared to the LMM is due to the inclusion of surface hydrology. Future research should continue assessing the effect of high-resolution climate modelling in impact-based forecasting.

ICPD at 30 - What African countries need to do better.

In September 1994, the International Conference on Population and Development (ICPD), that gave birth to the doctrine of sexual and reproductive health and rights (SRHR), was held in Cairo, Egypt1. This year is the 30th year following the conference. Given that a total of 179 governments attended the ICPD and agreed to the Platform for Action for promoting and improving sexual and reproductive health and rights, it is appropriate to take stock of changes, expectations, and commitments that have occurred as a result of actions taken by governments. The 57th session of the Commission on Population and Development will be held in April 2024 and will be dedicated to assessing the status of sexual and reproductive health and rights 30 years after Cairo. Additional post-30years events will take place in Geneva, Switzerland in October 19-20, 2024 which are intended to enable the global community to take a look backwards identify ways in which the ICPD processes have influenced global development.

En septembre 1994, la Conférence internationale sur la population et le développement (CIPD), qui a donné naissance à la doctrine de la santé et des droits sexuels et reproductifs (SDSR), s'est tenue au Caire, en Égypte1. Cette année marque la 30e année après la conférence. Étant donné qu'un total de 179 gouvernements ont participé à la CIPD et ont accepté le Programme d'action pour promouvoir et améliorer la santé et les droits sexuels et reproductifs, il convient de faire le point sur les changements, les attentes et les engagements qui se sont produits à la suite des mesures prises. par les gouvernements. La 57e session de la Commission sur la population et le développement se tiendra en avril 2024 et sera consacrée à l'évaluation de l'état de la santé et des droits sexuels et reproductifs 30 ans après. D'autres événements post-30 ans auront lieu à Genève, en Suisse, les 19 et 20 octobre 2024, destinés à permettre à la communauté mondiale de jeter un regard en arrière et en avant pour identifier la manière dont les processus de la CIPD ont influencé le développement mondial.

Reaffirming the value of continuing professional development.

With advances in clinical knowledge and changing norms for health services delivery, lifelong learning is essential for practitioners of sexual and reproductive health. Clinical topics should be complemented by various items, such as communications and management, to optimise the provision of care. Aiming to update knowledge, improve skills and enhance competence, professional development can take the form of diverse modalities ranging from the reading of professional journals through attendance at meetings to formal participation in schemes organised by licensing authorities. Already mandatory in numerous countries in Africa, continuing professional development is assuming more importance for medical, nursing, and midwifery practitioners.

Avec les progrès des connaissances cliniques et l'évolution des normes en matière de prestation de services de santé, l'apprentissage tout au long de la vie est essentiel pour les praticiens de la santé sexuelle et reproductive. Les sujets cliniques doivent être complétés par divers éléments, tels que la communication et la gestion, pour optimiser la prestation des soins. Visant à mettre à jour les connaissances, à améliorer les compétences et à améliorer les compétences, le développement professionnel peut prendre la forme de diverses modalités allant de la lecture de revues professionnelles à la participation à des réunions en passant par la participation formelle à des programmes organisés par les autorités chargées des licences. Déjà obligatoire dans de nombreux pays d'Afrique, la formation professionnelle continue prend de plus en plus d'importance pour les praticiens médicaux, infirmiers et obstétricaux.

Conceptualisation and implementation of integrated disease surveillance globally: a scoping review.

OBJECTIVES: The objective of this study was to examine the conceptualisation and operationalisation of Integrated Disease Surveillance (IDS) systems globally and the evidence for their effectiveness. Furthermore, to determine whether the recommendations made by Morgan et al. are supported by the evidence and what the evidence is to inform country development of IDS. STUDY DESIGN: The study incorporated a scoping review. METHODS: This review summarised evidence meeting the following inclusion criteria: Participants: any health sector; Concept: IDS; and Context: global. We searched Medline, Embase, and Epistemonikos for English publications between 1998 and 2022. Standard review methods were applied. A bespoke conceptual framework guided the narrative analysis. This scoping review is part of a research programme with three key elements, with the other studies being a survey of the International Association of National Public Health Institutes members on the current status of their disease surveillance systems and a deeper analysis and case studies of the surveillance systems in seven countries, to highlight the opportunities and challenges of integration. RESULTS: Eight reviews and five primary studies, which were assessed as being of low quality, were included, mostly examining IDS in Africa, the human sector, and communicable diseases. None reported on the effects on disease control or on the evolution of IDS during the COVID-19 pandemic. Descriptions of IDS and of integration varied. Prerequisites of effective IDS systems mostly related to the adequacy of core functions and resourcing requirements. Laws or regulations supporting system integration and data sharing were not addressed. The provision of core functions and resourcing requirements were described as inadequate, financing as non-sustainable, and governance as poor. Enablers included active data sharing, close cooperation between agencies, clear reporting channels, integration of vertical programs, increased staff training, and adopting mobile reporting. Whilst the conceptual framework for IDS and Morgan et al.'s proposed principles were to some extent reflected in the highlighted priorities for IDS in the literature, the evidence base remains weak. CONCLUSIONS: Available evidence is fragmented, incomplete, and of poor quality. The review found a lack of robust evaluation studies on the impact of IDS on disease control. Whilst a lack of evidence does not imply a lack of benefit or effect, it should signal the need to evaluate the process and impact of integration in the future development of surveillance systems. A common IDS definition and articulation of the parts that constitute an IDS system are needed. Further robust impact evaluations, as well as country reviews and evaluations of their IDS systems, are required to improve the evidence base.