Antibiotic use by clinical presentation across all healthcare providers in rural Burkina Faso: a healthcare visit exit survey.

BACKGROUND: To guide antibiotic stewardship interventions, understanding for what indications antibiotics are used is essential. METHODS: In rural Burkina Faso, we measured antibiotic dispensing across all healthcare providers. From October 2021 to February 2022, we surveyed patients in Nanoro district, Burkina Faso, following visits to health centres (3), pharmacies (2), informal medicine vendors (5) and inpatients in health centres. We estimated prevalence of antibiotic use and the proportion of Watch group antibiotics by provider type and by clinical presentation, assessing compliance with WHO's AWaRe Antibiotic Book. We estimated per capita antibiotic use by multiplying prevalence of antibiotic use, mean DDD per adult treatment course, and the rate of healthcare visits per 1000 inhabitants per day, estimated from a prior household survey. RESULTS: Outpatient antibiotic use was more frequent after health centre visits (54.8%, of which 16.5% Watch, n = 1249) than after visits to pharmacies (26.2%, 16.3% Watch, n = 328) and informal medicine vendors (26.9%, 50.0% Watch, n = 349). The frequency of antibiotic use was highest for bronchitis (79.9% antibiotic use, of which 12.6% Watch), malaria (31.9%, 23.1% Watch), gastroenteritis (76.0%, 31.7% Watch), rhinopharyngitis (40.4%, 8.3% Watch) and undifferentiated fever (77.0%, 44.8% Watch). Compliance with WHO AWaRe guidance could have averted at least 68.4% of all Watch antibiotic use in outpatients at health centres. Community-wide, 2.9 DDD (95% CI 1.9-3.9) were used per 1000 adult inhabitants per day. CONCLUSIONS: Most Watch antibiotic use at community level or primary care deviated from WHO guidance. Antibiotic stewardship should focus on key clinical presentations and include primary care and self-medication.

Women Anesthesiologists in Sub-Saharan Africa in the Pre-COVID Era: A Multinational Demographic Study.

BACKGROUND: Gender imbalance and poor representation of women complicate the anesthesiology workforce crisis in sub-Saharan Africa (SSA). This study was performed to obtain a better understanding of gender disparity among medical graduates and anesthesiologists in SSA. METHODS: Using a quantitative, participatory, insider research study, led by female anesthesiologists as the national coordinators in SSA, we collected data from academic or national health authorities and agencies. National coordinators were nominees of anesthesiology societies that responded to our email invitations. Data gathered from 13 countries included information on medical graduates, anesthesiologists graduating between 1998 and 2021, and number of anesthesiologists licensed to practice in 2018. We compared data between Francophone and Anglophone countries, and between countries in East Africa and West Africa/Central Africa. We calculated anesthesiology workforce densities and compared representation of women among graduating anesthesiologists and medical graduates.Data analysis was performed using linear regression. We used F-tests on regression slopes to assess the trends in representation of women over the years and the differences between the slopes. A value of P < .050 was considered statistically significant. RESULTS: Over a 20-year period, the representation of female medical graduates in SSA increased from 29% (1998) to 41% (2017), whereas representation of female anesthesiologists was inconsistent, with an average of 25%, and lagged behind. Growth and gender disparity patterns were different between West Africa/Central Africa and East Africa. Representation of female anesthesiologists was higher in East Africa (39.4%) than West Africa/Central Africa (19.7%); and the representation of female medical graduates in East Africa (42.5%) was also higher that West Africa/Central Africa (33.1%). CONCLUSIONS: On average, in SSA, female medical graduates (36.9%), female anesthesiologists (24.9%), and female anesthesiology residents projected to graduate between 2018 and 2022 (25.2%) were underrepresented when compared to their male counterparts. Women were underrepresented in SSA, despite evidence that their representation in medicine and anesthesiology in East African countries was rising.

Serum Neurofilament Light and Postoperative Delirium in Cardiac Surgery: A Preplanned Secondary Analysis of a Prospective Observational Study.

BACKGROUND: Impaired cognition is a major predisposing factor for postoperative delirium, but it is not systematically assessed. Anesthesia and surgery may cause postoperative delirium by affecting brain integrity. Neurofilament light in serum reflects axonal injury. Studies evaluating the perioperative course of neurofilament light in cardiac surgery have shown conflicting results. The authors hypothesized that postoperative serum neurofilament light values would be higher in delirious patients, and that baseline concentrations would be correlated with patients' cognitive status and would identify patients at risk of postoperative delirium. METHODS: This preplanned secondary analysis included 220 patients undergoing elective cardiac surgery with cardiopulmonary bypass. A preoperative cognitive z score was calculated after a neuropsychological evaluation. Quantification of serum neurofilament light was performed by the Simoa (Quanterix, USA) technique before anesthesia, 2 h after surgery, on postoperative days 1, 2, and 5. Postoperative delirium was assessed using the Confusion Assessment Method for Intensive Care Unit, the Confusion Assessment Method, and a chart review. RESULTS: A total of 65 of 220 (29.5%) patients developed postoperative delirium. Delirious patients were older (median [25th percentile, 75th percentile], 74 [64, 79] vs. 67 [59, 74] yr; P < 0.001) and had lower cognitive z scores (-0.52 ± 1.14 vs. 0.21 ± 0.84; P < 0.001). Postoperative neurofilament light concentrations increased in all patients up to day 5, but did not predict delirium when preoperative concentrations were considered. Baseline neurofilament light values were significantly higher in patients who experienced delirium. They were influenced by age, cognitive z score, renal function, and history of diabetes mellitus. Baselines values were significantly correlated with cognitive z scores (r, 0.49; P < 0.001) and were independently associated with delirium whenever the patient's cognitive status was not considered (hazard ratio, 3.34 [95% CI, 1.07 to 10.4]). CONCLUSIONS: Cardiac surgery is associated with axonal injury, because neurofilament light concentrations increased postoperatively in all patients. However, only baseline neurofilament light values predicted postoperative delirium. Baseline concentrations were correlated with poorer cognitive scores, and they independently predicted postoperative delirium whenever patient's cognitive status was undetermined.

Correction: Suh Nchang et al. Knowledge about Asymptomatic Malaria and Acceptability of Using Artemisia afra Tea among Health Care Workers (HCWs) in Yaoundé, Cameroon: A Cross-Sectional Survey. Int. J. Environ. Res. Public Health 2023, 20, 6309.

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Facteurs associés au petit poids de naissance des enfants en République démocratique du Congo: Analyse secondaire des données de l'Enquête démographique et sanitaire 2013-2014 / NA

La République démocratique du Congo comme d'autres pays à faible revenu est confronté à une prévalence élevée de petit poids des enfants à la naissance. Des prévalences atteignant 15, 16% ont été signalées dans quelques rares études menées dans certaines provinces, démontrant encore l'ampleur du problème malgré l'absence des recherches à l'échelle nationale. Notre étude a pour objectif principal de déterminer l'influence des facteurs sociodémographiques, individuels et obstétricaux sur le petit poids de naissance afin d'élucider la problématique et proposer certaines pistes de solution allant dans le sens d'atteindre la cible de l'OMS à l'horizon 2025. Notre étude est transversale analytique basée sur la population. Les données proviennent de l'enquête démographique et sanitaire'(EDS RDC 2013-2014). Ces données ont été recueillies auprès des femmes en âge de procréer habitant dans les ménages. Nous avons estimé la prévalence globale ainsi que d'autres prévalences se rapportant aux deux sous catégories des femmes identifiées lors de l'analyse. Les facteurs ont été identifiés au moyen d'une régression multivariée. La prévalence globale était de 7%. «La primiparité, l'intervalle inter génésique, le nombre des visites prénatales et le milieu de résidence de la femme étaient significativement associés au petit poids de naissance. La présente étude réaffirme l'association des certains facteurs maternels plus que les autres dans la survenue des petits poids de naissance en République démocratique du Congo.

The Democratic Republic of Congo, like other low-income countries, faces a high prevalence of low birth weight. Prevalences as high as 15.16% have been reported in a few rare studies conducted in some provinces, further demonstrating the scale of the problem despite the absence of national-scale research. The main objective of our study is to determine the influence of sociodemographic, individual and obstetric factors on low birth weight in order to elucidate the problem and propose certain possible solutions in the direction of achieving the WHO target of the horizon 2025. Our study is transversal analytical based on the population. The data comes from the demographic and health survey (EDS RDC 2013-2014). These data were collected from women of childbearing age living in households. We estimated the overall prevalence as well as other prevalences relating to the twosubcategories of women identified during the analysis. Factors were identified using multivariate regression. The overall prevalence was 7%. "Primiparity, inter-birth interval, number of prenatal visits and the woman's place of residence were significantly associated with low birth weight. The present study reaffirms the association of certain maternal factors more than others in the occurrence of low birth weight in the Democratic Republic of Congo