RESUMEN
BACKGROUND: Malaria during pregnancy continues to be a significant cause of morbidity and mortality for both infants and mothers, particularly in sub-Saharan African (SSA) countries, despite increased efforts to control it. The utilization of long-lasting insecticide-treated nets (LLINs) during pregnancy is a well-established strategy to reduce the prevalence of malaria. Nonetheless, inadequate adherence remains a persistent challenge in certain regions with high malaria endemicity. This research aimed to assess the effectiveness of long-lasting insecticidal nets in preventing asymptomatic malaria infections among pregnant women attending antenatal care at the Bonassama District Hospital in the Littoral Region of Cameroon. METHODS: A hospital-based cross-sectional study was conducted from March to June 2022. Data on sociodemographic characteristics and LLIN usage were collected through a structured questionnaire, while asymptomatic malaria infections were identified using a PfHRP2/pLDH malaria qualitative rapid diagnostic kit. The relationship between categorical variables was analyzed using the chi-square test and logistic regression at a significance level of 5%. RESULTS: Out of the 411 pregnant women included in the study, 35.4% were diagnosed with malaria. The LLIN utilization rate was 65.1%. The risk of malaria infection was 2.7 times higher (AOR = 2.75, 95% CI = 1.83-4.14, p < 0.001) among women who did not consistently use LLINs compared to those who did. Pregnant women in their first trimester (AOR = 3.40, 95% CI = 1.24-4.64, p = 0.010) and second trimester (AOR = 1.90, 95%CI = 0.99-3.62, p = 0.055) were more likely to sleep under net when compared to those in the third trimester. Younger women 20-29 years (71.4%), those in the first trimester (69.6%) and those who had the nets before pregnancy (68.9%) were amongst those who frequently used use the nets. Among the reasons reported for not frequently using LLINs were heat (55.2%), suffocation (13.6%) and the smell of nets (8.4%). CONCLUSION: The use of LLIN was moderately high among the participants in this study, though still below national target. Age group, religion and gestation period were the major factors determining the use of LLINs. Considering the proven effectiveness of LLINs in reducing malaria morbidity and mortality, it is imperative for the National Malaria Control Programme (NMCP) to remain focused in promoting both LLIN ownership and utilization to achieve the national target of 100% and 80%, respectively.
Asunto(s)
Hospitales de Distrito , Mosquiteros Tratados con Insecticida , Malaria Falciparum , Complicaciones Parasitarias del Embarazo , Atención Prenatal , Humanos , Femenino , Camerún/epidemiología , Embarazo , Mosquiteros Tratados con Insecticida/estadística & datos numéricos , Estudios Transversales , Adulto , Atención Prenatal/estadística & datos numéricos , Prevalencia , Malaria Falciparum/prevención & control , Malaria Falciparum/epidemiología , Adulto Joven , Complicaciones Parasitarias del Embarazo/prevención & control , Complicaciones Parasitarias del Embarazo/epidemiología , Adolescente , Control de Mosquitos/métodosRESUMEN
BACKGROUND: Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be "master trainers". These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018-2019 school year and 285 in 2019-2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. CONCLUSIONS: With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution.
Asunto(s)
Servicios de Salud Rural , Estudiantes de Enfermería , Atención a la Salud , República Democrática del Congo , Instituciones de Salud , Humanos , Facultades de EnfermeríaRESUMEN
BACKGROUND: The purpose of this study is to determine: (i) the concordance between a combination of hemoglobin A(1c) (Hb(A1c)) and fasting plasma glucose (FPG) (Hb(A1c) + FPG) and a combination of FPG and 2-h plasma glucose (2hPG) (FPG + 2hPG); and (ii) whether substituting FPG + 2hPG with Hb(A1c) + FPG can enhance the detection of prediabetes in diabetes-free non-Hispanic Whites, non-Hispanic Blacks, and Mexican-Americans adults. METHODS: Data (n = 1376) from the 2007 to 2008 U.S. National Health and Nutrition Examination Surveys were used for this investigation. Prediabetes cut points were determined using 5.7-6.4%, 100-125, and 140-199 mg/dL for Hb(A1c), FPG, and 2hPG, respectively. Concordances between Hb(A1c) and FPG, Hb(A1c) and 2hPG, Hb(A1c) + FPG and FPG + 2hPG in screening for undiagnosed prediabetes were determined using sensitivity, specificity, and positive and negative likelihood ratios. RESULTS: The overall concordance between Hb(A1c) + FPG and FPG + 2hPG in screening for prediabetes was high, as indicated by a sensitivity of 92.4% (95% CI = 90.5-94.5) and specificity of 84.1% (81.2-87.0). The application of Hb(A1c) + FPG was associated with a higher prevalence of prediabetes compared to FPG + 2hPG. Compared with FPG + 2hPG, screening with Hb(A1c) + FPG was associated with 3.2%, 24.3%, and 4.2% relative increases in the identification of prediabetes in nondiabetic non-Hispanic Whites, non-Hispanic Blacks and Mexican-Americans, respectively. CONCLUSIONS: The enhanced prevalence of prediabetes using Hb(A1c) + FPG compared with FPG + 2hPG calls for the need to redefine at a more basic and practical level how to apply Hb(A1c) in screening for prediabetes. A redefined Hb(A1c) that incorporates FPG, age, race/ethnicity, and body mass index may be a better way to use Hb(A1c) in population-based and clinical settings.
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Glucemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Hemoglobina Glucada/metabolismo , Estado Prediabético/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/sangre , Etnicidad , Ayuno , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Estado Prediabético/sangre , PrevalenciaRESUMEN
As of 2010 sub-Saharan Africa had approximately 865 million inhabitants living with numerous public health challenges. Several public health initiatives [e.g., the United States (US) President's Emergency Plan for AIDS Relief and the US President's Malaria Initiative] have been very successful at reducing mortality from priority diseases. A competently trained public health workforce that can operate multi-disease surveillance and response systems is necessary to build upon and sustain these successes and to address other public health problems. Sub-Saharan Africa appears to have weathered the recent global economic downturn remarkably well and its increasing middle class may soon demand stronger public health systems to protect communities. The Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC) has been the backbone of public health surveillance and response in the US during its 60 years of existence. EIS has been adapted internationally to create the Field Epidemiology Training Program (FETP) in several countries. In the 1990s CDC and the Rockefeller Foundation collaborated with the Uganda and Zimbabwe ministries of health and local universities to create 2-year Public Health Schools Without Walls (PHSWOWs) which were based on the FETP model. In 2004 the FETP model was further adapted to create the Field Epidemiology and Laboratory Training Program (FELTP) in Kenya to conduct joint competency-based training for field epidemiologists and public health laboratory scientists providing a master's degree to participants upon completion. The FELTP model has been implemented in several additional countries in sub-Saharan Africa. By the end of 2010 these 10 FELTPs and two PHSWOWs covered 613 million of the 865 million people in sub-Saharan Africa and had enrolled 743 public health professionals. We describe the process that we used to develop 10 FELTPs covering 15 countries in sub-Saharan Africa from 2004 to 2010 as a strategy to develop a locally trained public health workforce that can operate multi-disease surveillance and response systems.
Asunto(s)
Epidemiología/educación , Personal de Laboratorio/educación , Evaluación de Necesidades/estadística & datos numéricos , Salud Pública , África del Sur del Sahara , Factores de TiempoRESUMEN
The Central African Field Epidemiology and Laboratory Training Program (CAFELTP) is a 2-year public health leadership capacity building training program. It was established in October 2010 to enhance capacity for applied epidemiology and public health laboratory services in three countries: Cameroon, Central African Republic, and the Democratic Republic of Congo. The aim of the program is to develop a trained public health workforce to assure that acute public health events are detected, investigated, and responded to quickly and effectively. The program consists of 25% didactic and 75% practical training (field based activities). Although the program is still in its infancy, the residents have already responded to six outbreak investigations in the region, evaluated 18 public health surveillance systems and public health programs, and completed 18 management projects. Through these various activities, information is shared to understand similarities and differences in the region leading to new and innovative approaches in public health. The program provides opportunities for regional and international networking in field epidemiology and laboratory activities, and is particularly beneficial for countries that may not have the immediate resources to host an individual country program. Several of the trainees from the first cohort already hold leadership positions within the ministries of health and national laboratories, and will return to their assignments better equipped to face the public health challenges in the region. They bring with them knowledge, practical training, and experiences gained through the program to shape the future of the public health landscape in their countries.