Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry.

BACKGROUND: Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. METHODS: We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. RESULTS: The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47-2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22-1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52-2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03-1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02-1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02-1.37, p = 0.027). CONCLUSION: We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.

Ebola outbreak in DRC and Uganda; an East African public health concern.

On August 21, 2022, healthcare authorities in the Democratic Republic of the Congo (DRC) announced an outbreak of Ebola virus disease in North Kivu Province, bringing the total to 15 outbreaks nationwide. On September 20, 2022, Uganda's authorities declared an outbreak of the Sudan strain of the Ebola virus following a confirmed a case in Mubende district. As of October 6, 2022, the reported numbers of cases were 63, with 29 deaths in Uganda and 1 case with 1 death in DRC, respectively. Ebola virus causes an acute and severely fatal illness, resulting in death within a very short time if left untreated. In addition, these outbreaks in DRC and Uganda pose a major threat to the health and socioeconomic well-being of the people of East Africa due to multiple cross-border activities. Adequate preparations need to be made by the healthcare authorities of the nations concerned; the government, healthcare workers, and the East-African community as a whole have important roles to play in the effective prevention and control of the spread of Ebola virus within and across their borders.

Public health concerns about Tuberculosis caused by Russia/Ukraine conflict.

According to WHO, Ukraine has the fourth-highest Tuberculosis (TB) incidence in the WHO European region while globally has the fifth-highest number of confirmed cases of extensively drug-resistant TB. Before the Russian invasion in Ukraine several interventions have been employed to mitigate the TB epidemic in the country. However, the ongoing war has demolished meticulous efforts and subsequently worsen the situation. WHO in collaboration with the Ukraine government and other organizations such as EU and UK are required to take up arms against the situation. In this work, implications brought up from the war, efforts, and recommendations to battling TB epidemic due to the war are highlighted.

Monkeypox virus: A zoonosis of concern.

An outbreak of Monkeypox detected in nonendemic regions outside Africa has received much attention around the globe. In this letter, we highlight epidemiology, pathogenesis, diagnosis, and recommendations to mitigate the spread of monkeypox.

Ukraine's triple emergency: Food crisis amid conflicts and COVID-19 pandemic.

Globally, both Russia and Ukraine play a key role in food production. Both countries are known for their meticulous positions in producing and exporting wheat, maize, sunflower seed oil, and cotton seed oil. Although the conflict between Russia and Ukraine has been going on for more than 5 years, the recent invasion of Russia in Ukraine has endangered food security in Ukraine during the COVID-19 pandemic. As COVID-19 cripples the healthcare infrastructure of Ukraine, food insecurity challenges the civilian population to migration. As the conflict intensitifes, damages to properties, loss of lives, rise of infectious diseases, incremental rise in energy prices, and fuel consumption are some of the possible consequences. This commentary aims to highlight the different ways in which access to food has been endangered, the implications that food crisis has on the world, and thus provide key recommendations on what needs to be addressed to mitigate the rising risks of the food crisis in the world.

Water sanitation problem in Pakistan: A review on disease prevalence, strategies for treatment and prevention.

The global water crisis is expected to worsen if urgent action is not taken in making sustainable amends. This applies to Pakistan as the entire country suffers massively from poor water sanitation. Waterborne diseases are rising exponentially attributed to rise in microbial infestations, trace elements and drug toxicity in many water bodies of Pakistan. Treatment and prevention strategies must be implemented through national authorities and at the individual level. Awareness on use of clean water must be emphasized and proper administration on water management policies should be implemented. Immediate and active sustainability for water resources can ensure a safer future for Pakistan.

Challenges faced by African healthcare workers during the third wave of the pandemic.

Africa experienced the third wave of the coronavirus disease in 2019, which caused an 18% rise in cases in most parts of the continent. As of January 2022, the region had an estimated 10.4 million cumulative cases and more than 233,000 deaths, which add up to the burden on the fragile healthcare system, which continues to face a shortage of staff and resources. In addition, the progression of the pandemic further threatens the supply of healthcare workers in Africa due to the increased risk of infection and death, where more than 10,000 healthcare workers in 40 countries have been infected with the virus. This is amid low vaccination coverage, with only 27% of healthcare workers in Africa being fully vaccinated against the disease. Despite the delayed start and slow progression of the pandemic in Africa, there are increasing concerns over the challenges on the African healthcare workers such as economic insecurity and stressful working conditions, which are associated with limited access to personal protective equipment and other vital resources such as ventilators. In addition, the pandemic further predisposes African healthcare workers to social stigma, burnout, insomnia, depression, and fear of safety in their families. The aim of this study is to highlight the challenges faced by African healthcare workers, provide recommendations for change, and emphasize the need to prioritize their physical and mental well-being.

Measles outbreak in sub-Saharan Africa amidst COVID-19: A rising concern, efforts, challenges, and future recommendations.

In Sub-Saharan Africa, the number cases of Measles have spiked by 400%, some of the countries affected being Ethiopia, Somalia and Democratic Republic of the Congo. This is due to the emergence of COVID-19 which has disrupted the global fight against Measles by impairing the routine immunization programs. This has led to suspension of the measles vaccination drive, where about 23 million children missed out on all basic childhood vaccines including Measles-Mumps-Rubella vaccine in Sub-Saharan Africa. Despite the efforts to conduct mass immunization campaign for Measles in some countries, there is a need to build stronger health systems that would provide education to promote awareness and commitment to routine Measles vaccination and provide Vitamin A supplements to boost immunity.

Dengue fever outbreak in Cook Island: A rising concern, efforts, challenges, and future recommendations.

The Cook Island government has made several efforts to ensure zero confirmed cases and transmission of COVID-19, especially among visiting travelers. However, the Cook Island ministry of health has to deal with the new strain of dengue fever outbreak, known as dengue fever type 2 (DEN-2), by adopting several measures to control its spread, especially in the affected parts of the subtropical country. This paper aims to describe the dengue fever response taken in Cook Island and suggest recommendations to control the risk of transmission in endemic parts of the world.