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1.
Artigo em Inglês | MEDLINE | ID: mdl-33803352

RESUMO

Eighty percent of people with stroke live in low- to middle-income nations, particularly in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades. More than one-third of all epilepsy-related deaths occur in SSA. HIV infection is a risk factor for neurological disorders, including stroke and epilepsy. The vast majority of the 38 million people living with HIV/AIDS are in SSA, and the burden of neurological disorders in SSA parallels that of HIV/AIDS. Local healthcare systems are weak. Many standalone HIV health centres have become a platform with combined treatment for both HIV and noncommunicable diseases (NCDs), as advised by the United Nations. The COVID-19 pandemic is overwhelming the fragile health systems in SSA, and it is feared it will provoke an upsurge of excess deaths due to the disruption of care for chronic diseases such as HIV, TB, hypertension, diabetes, and cerebrovascular disorders. Disease Relief through Excellent and Advanced Means (DREAM) is a health programme active since 2002 to prevent and treat HIV/AIDS and related disorders in 10 SSA countries. DREAM is scaling up management of NCDs, including neurologic disorders such as stroke and epilepsy. We described challenges and solutions to address disruption and excess deaths from these diseases during the ongoing COVID-19 pandemic.


Assuntos
Epilepsia , Infecções por HIV , Acidente Vascular Cerebral , África ao Sul do Saara/epidemiologia , Epilepsia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Pandemias , Acidente Vascular Cerebral/epidemiologia
2.
PLoS Negl Trop Dis ; 15(3): e0009088, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33661903

RESUMO

The neglected tropical diseases (NTDs) affect hundreds of millions of people, predominantly in rural, often difficult-to-access areas, poorly served by national health services. Here, we review the contributions of 4.8 million community-directed distributors (CDDs) of medicines over 2 decades in 146,000 communities in 27 sub-Saharan African countries to control or eliminate onchocerciasis and lymphatic filariasis (LF). We examine their role in the control of other NTDs, malaria, HIV/AIDS interventions, immunisation campaigns, and support to overstretched health service personnel. We are of the opinion that CDDs as community selected, trained, and experienced "foot soldiers," some of whom were involved in the Ebola outbreak responses at the community level in Liberia, if retrained, can assist community leaders and support health workers (HWs) in the ongoing Coronavirus Disease 2019 (COVID-19) crisis. The review highlights the improved treatment coverage where there are women CDDs, the benefits and lessons from the work of CDDs, their long-term engagement, and the challenges they face in healthcare delivery. It underscores the value of utilising the CDD model for strong community engagement and recommends the model, with some review, to hasten the achievement of the NTD 2030 goal and assist the health system cope with evolving epidemics and other challenges. We propose that, based on the unprecedented progress made in the control of NTDs directly linked to community engagement and contributions of CDDs "foot soldiers," they deserve regional and global recognition. We also suggest that the World Health Organization (WHO) and other international stakeholders promote policy and guidance for countries to adapt this model for the elimination of NTDs and to strengthen national health services. This will enhance the accomplishment of some Sustainable Development Goals (SDGs) by 2030 in sub-Saharan Africa.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Filariose Linfática/terapia , Administração Massiva de Medicamentos , Doenças Negligenciadas/terapia , Oncocercose/terapia , África ao Sul do Saara , Agentes Comunitários de Saúde , Filariose Linfática/prevenção & controle , Feminino , Humanos , Ivermectina/administração & dosagem , Doenças Negligenciadas/prevenção & controle , Oncocercose/prevenção & controle
3.
N Engl J Med ; 384(11): 1003-1014, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33730454

RESUMO

BACKGROUND: Whether a broadly neutralizing antibody (bnAb) can be used to prevent human immunodeficiency virus type 1 (HIV-1) acquisition is unclear. METHODS: We enrolled at-risk cisgender men and transgender persons in the Americas and Europe in the HVTN 704/HPTN 085 trial and at-risk women in sub-Saharan Africa in the HVTN 703/HPTN 081 trial. Participants were randomly assigned to receive, every 8 weeks, infusions of a bnAb (VRC01) at a dose of either 10 or 30 mg per kilogram (low-dose group and high-dose group, respectively) or placebo, for 10 infusions in total. HIV-1 testing was performed every 4 weeks. The VRC01 80% inhibitory concentration (IC80) of acquired isolates was measured with the TZM-bl assay. RESULTS: Adverse events were similar in number and severity among the treatment groups within each trial. Among the 2699 participants in HVTN 704/HPTN 085, HIV-1 infection occurred in 32 in the low-dose group, 28 in the high-dose group, and 38 in the placebo group. Among the 1924 participants in HVTN 703/HPTN 081, infection occurred in 28 in the low-dose group, 19 in the high-dose group, and 29 in the placebo group. The incidence of HIV-1 infection per 100 person-years in HVTN 704/HPTN 085 was 2.35 in the pooled VRC01 groups and 2.98 in the placebo group (estimated prevention efficacy, 26.6%; 95% confidence interval [CI], -11.7 to 51.8; P = 0.15), and the incidence per 100 person-years in HVTN 703/HPTN 081 was 2.49 in the pooled VRC01 groups and 3.10 in the placebo group (estimated prevention efficacy, 8.8%; 95% CI, -45.1 to 42.6; P = 0.70). In prespecified analyses pooling data across the trials, the incidence of infection with VRC01-sensitive isolates (IC80 <1 µg per milliliter) per 100 person-years was 0.20 among VRC01 recipients and 0.86 among placebo recipients (estimated prevention efficacy, 75.4%; 95% CI, 45.5 to 88.9). The prevention efficacy against sensitive isolates was similar for each VRC01 dose and trial; VRC01 did not prevent acquisition of other HIV-1 isolates. CONCLUSIONS: VRC01 did not prevent overall HIV-1 acquisition more effectively than placebo, but analyses of VRC01-sensitive HIV-1 isolates provided proof-of-concept that bnAb prophylaxis can be effective. (Supported by the National Institute of Allergy and Infectious Diseases; HVTN 704/HPTN 085 and HVTN 703/HPTN 081 ClinicalTrials.gov numbers, NCT02716675 and NCT02568215.).


Assuntos
Anticorpos Monoclonais/uso terapêutico , Anticorpos Amplamente Neutralizantes/uso terapêutico , Anticorpos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , HIV-1 , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , América/epidemiologia , Anticorpos Monoclonais/efeitos adversos , Anticorpos Amplamente Neutralizantes/efeitos adversos , Método Duplo-Cego , Europa (Continente)/epidemiologia , Feminino , Anticorpos Anti-HIV/efeitos adversos , Infecções por HIV/epidemiologia , HIV-1/efeitos dos fármacos , Humanos , Incidência , Masculino , Estudo de Prova de Conceito , Adulto Jovem
4.
West Afr J Med ; 38(3): 246-254, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33765376

RESUMO

BACKGROUND: One gynecological disorder which is often a mystery to premenopausal women who are affected is endometriosis, a benign condition characterized by ectopic endometrium growing outside the uterus but behaving as if it is still within the uterus. MATERIALS AND METHODS: Hospital records of 226 women who consulted for fertility management at Nordica Fertility Center were surveyed retrospectively. These women were stratified by age into <35 years and >35 years and by BMI into <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight) and >30 (obese). There were 113 who had laparoscopic diagnosis of endometriosis and 113 without endometriosis but just infertility. STATA 13 statistical software was used for analysis of data. RESULTS: The mean (±sd) age of the women in the study was 34.3 (4.9) with no significant difference among those with (33.9 (4.3)) and without (34.6 (5.4)) endometriosis. There was a significant difference (t=-3.36, P-value=0.0005) in the mean BMI (Kg/m2) of women with endometriosis (25.8±4.9) compared to that of women without endometriosis (27.9±4.5). The probability of endometriosis among normal weight women was higher at age <35 years (OR=2.76, 95% Confidence Interval 1.33,5.73) than at age >35 years (OR=1.59, 95% Confidence Interval 0.62, 4.10). The mean (±SD) parity among those with endometriosis (0.13±0.34) was significantly lower (t-test=2.31; P-value=0.01) than that among women without endometriosis (0.28 ± 0.60). Primary infertility was more prevalent (62.0%) than secondary infertility (38.0%) among those with endometriosis while secondary infertility was more prevalent (55.8%) than primary infertility (44.3%) among those without endometriosis. The mean age (years) at menarche of women without endometriosis (13.3±1.6) was significantly higher (t-test=1.88, P-value=0.03) than that among those with endometriosis (12.9±1). Those with endometriosis were most likely to have dysmenorrhea alone, menorrhagia alone and both dysmenorrhea and menorrhagia concurrently than those without the disease. CONCLUSION: Anthropometric and abnormal menstrual profile of patients presenting with pelvic pain, co-morbidity of dysmenorrhea and menorrhagia, infertility and low parity can guide clinicians and gynecologist to make early and proper diagnosis of endometriosis for better treatment outcomes.


Assuntos
Endometriose , Adulto , África ao Sul do Saara , Afro-Americanos , Dismenorreia , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/epidemiologia , Feminino , Humanos , Gravidez , Estudos Retrospectivos
5.
Adv Exp Med Biol ; 1321: 147-162, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33656721

RESUMO

The novel corona virus 2019 (COVID-19) outbreak which started in Hubei province in China has now spread to every corner of the earth. While the pandemic started later in Africa, it is now found in all African countries to varying degrees. It is thought that the prevalence and severity of disease is influenced by a number of non-communicable diseases (NCDs) which are all becoming increasingly prevalent in sub-Saharan Africa (SSA). In addition, SSA bears the major burden of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. While data from Europe and the United States show that children are spared severe disease, it is uncertain if the same holds true in SSA where children suffer from sickle cell disease and malnutrition in addition to other infectious diseases. There is limited data from Africa on the effects of these conditions on COVID-19. In this review, we discuss the epidemiology of some of these conditions in Africa and the possible pathogenesis for the interactions of these with COVID-19.


Assuntos
Coronavirus , África ao Sul do Saara/epidemiologia , Criança , China , Europa (Continente) , Humanos , Estados Unidos , Populações Vulneráveis
6.
Global Health ; 17(1): 24, 2021 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-33658050

RESUMO

OBJECTIVE: The COVID-19 pandemic is a biosecurity threat, and many resource-rich countries are stockpiling and/or making plans to secure supplies of vaccine, therapeutics, and diagnostics for their citizens. We review the products that are being investigated for the prevention, diagnosis, and treatment of COVID-19; discuss the challenges that countries in sub-Saharan Africa may face with access to COVID-19 vaccine, therapeutics, and diagnostics due to the limited capacity to manufacture them in Africa; and make recommendations on actions to mitigate these challenges and ensure health security in sub-Saharan Africa during this unprecedented pandemic and future public-health crises. MAIN BODY: Sub-Saharan Africa will not be self-reliant for COVID-19 vaccines when they are developed. It can, however, take advantage of existing initiatives aimed at supporting COVID-19 vaccine access to resource-limited settings such as partnership with AstraZeneca, the Coalition for Epidemic Preparedness and Innovation, the Global Alliance for Vaccine and Immunisation, the Serum Institute of India, and the World Health Organization's COVID-19 Technology Access Pool. Accessing effective COVID-19 therapeutics will also be a major challenge for countries in sub-Saharan Africa, as production of therapeutics is frequently geared towards profitable Western markets and is ill-adapted to sub-Saharan Africa realities. The region can benefit from pooled procurement of COVID-19 therapy by the Africa Centres for Disease Control and Prevention in partnership with the African Union. If the use of convalescent plasma for the treatment of patients who are severely ill is found to be effective, access to the product will be minimally challenging since the region has a pool of recovered patients and human resources that can man supportive laboratories. The region also needs to drive the local development of rapid-test kits and other diagnostics for COVID-19. CONCLUSION: Access to vaccines, therapeutics, and diagnostics for COVID-19 will be a challenge for sub-Saharan Africans. This challenge should be confronted by collaborating with vaccine developers; pooled procurement of COVID-19 therapeutics; and local development of testing and diagnostic materials. The COVID-19 pandemic should be a wake-up call for sub-Saharan Africa to build vaccines, therapeutics, and diagnostics manufacturing capacity as one of the resources needed to address public-health crises.


Assuntos
/provisão & distribução , Indústria Farmacêutica/organização & administração , África ao Sul do Saara/epidemiologia , /tratamento farmacológico , Humanos
7.
Front Immunol ; 12: 565625, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33679730

RESUMO

Sub-Saharan Africa has generally experienced few cases and deaths of coronavirus disease 2019 (COVID-19). In addition to other potential explanations for the few cases and deaths of COVID-19 such as the population socio-demographics, early lockdown measures and the possibility of under reporting, we hypothesize in this mini review that individuals with a recent history of malaria infection may be protected against infection or severe form of COVID-19. Given that both the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Plasmodium falciparum (P. falciparum) merozoites bind to the cluster of differentiation 147 (CD147) immunoglobulin, we hypothesize that the immunological memory against P. falciparum merozoites primes SARS-CoV-2 infected cells for early phagocytosis, hence protecting individuals with a recent P. falciparum infection against COVID-19 infection or severity. This mini review therefore discusses the potential biological link between P. falciparum infection and COVID-19 infection or severity and further highlights the importance of CD147 immunoglobulin as an entry point for both SARS-CoV-2 and P. falciparum into host cells.


Assuntos
Basigina/imunologia , Memória Imunológica , Malária Falciparum , Plasmodium falciparum/imunologia , /imunologia , África ao Sul do Saara/epidemiologia , /imunologia , Humanos , Malária Falciparum/epidemiologia , Malária Falciparum/imunologia , Merozoítos/imunologia , Índice de Gravidade de Doença
8.
Nat Med ; 27(3): 447-453, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33531710

RESUMO

A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (for example, warmer environments1, younger populations2-4) have yet to be framed within a comprehensive analysis. We synthesized factors hypothesized to drive the pace and burden of this pandemic in SSA during the period from 25 February to 20 December 2020, encompassing demographic, comorbidity, climatic, healthcare capacity, intervention efforts and human mobility dimensions. Large diversity in the probable drivers indicates a need for caution in interpreting analyses that aggregate data across low- and middle-income settings. Our simulation shows that climatic variation between SSA population centers has little effect on early outbreak trajectories; however, heterogeneity in connectivity, although rarely considered, is likely an important contributor to variance in the pace of viral spread across SSA. Our synthesis points to the potential benefits of context-specific adaptation of surveillance systems during the ongoing pandemic. In particular, characterizing patterns of severity over age will be a priority in settings with high comorbidity burdens and poor access to care. Understanding the spatial extent of outbreaks warrants emphasis in settings where low connectivity could drive prolonged, asynchronous outbreaks resulting in extended stress to health systems.


Assuntos
/epidemiologia , /genética , Adulto , África ao Sul do Saara/epidemiologia , Idoso , Idoso de 80 Anos ou mais , /patologia , Comorbidade , Surtos de Doenças , Modificador do Efeito Epidemiológico , Feminino , História do Século XXI , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Mortalidade , Pandemias , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
9.
Cochrane Database Syst Rev ; 2: CD012882, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33565123

RESUMO

BACKGROUND: The leading causes of mortality globally in children younger than five years of age (under-fives), and particularly in the regions of sub-Saharan Africa (SSA) and Southern Asia, in 2018 were infectious diseases, including pneumonia (15%), diarrhoea (8%), malaria (5%) and newborn sepsis (7%) (UNICEF 2019). Nutrition-related factors contributed to 45% of under-five deaths (UNICEF 2019). World Health Organization (WHO) and United Nations Children's Fund (UNICEF), in collaboration with other development partners, have developed an approach - now known as integrated community case management (iCCM) - to bring treatment services for children 'closer to home'. The iCCM approach provides integrated case management services for two or more illnesses - including diarrhoea, pneumonia, malaria, severe acute malnutrition or neonatal sepsis - among under-fives at community level (i.e. outside of healthcare facilities) by lay health workers where there is limited access to health facility-based case management services (WHO/UNICEF 2012). OBJECTIVES: To assess the effects of the integrated community case management (iCCM) strategy on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for children younger than five years of age in low- and middle-income countries. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2019, Virtual Health Library on 8 November 2019, and Popline on 5 December 2018, three other databases on 22 March 2019 and two trial registers on 8 November 2019. We performed reference checking, and citation searching, and contacted study authors to identify additional studies. SELECTION CRITERIA: Randomized controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), interrupted time series (ITS) studies and repeated measures studies comparing generic WHO/UNICEF iCCM (or local adaptation thereof) for at least two iCCM diseases with usual facility services (facility treatment services) with or without single disease community case management (CCM). We included studies reporting on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for under-fives in low- and middle-income countries. DATA COLLECTION AND ANALYSIS: At least two review authors independently screened abstracts, screened full texts and extracted data using a standardised data collection form adapted from the EPOC Good Practice Data Collection Form. We resolved any disagreements through discussion or, if required, we consulted a third review author not involved in the original screening. We contacted study authors for clarification or additional details when necessary. We reported risk ratios (RR) for dichotomous outcomes and hazard ratios (HR) for time to event outcomes, with 95% confidence intervals (CI), adjusted for clustering, where possible. We used estimates of effect from the primary analysis reported by the investigators, where possible. We analysed the effects of randomized trials and other study types separately. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included seven studies, of which three were cluster RCTs and four were CBAs. Six of the seven studies were in SSA and one study was in Southern Asia. The iCCM components and inputs were fairly consistent across the seven studies with notable variation for the training and deployment component (e.g. on payment of iCCM providers) and the system component (e.g. on improving information systems). When compared to usual facility services, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (RR 0.96, 95% CI 0.77 to 1.19; 2 CBA studies, 5898 children; very low-certainty evidence). iCCM may have little to no effect on neonatal mortality (HR 1.01, 95% 0.73 to 1.28; 2 trials, 65,209 children; low-certainty evidence). We are uncertain of the effect of iCCM on infant mortality (HR 1.02, 95% CI 0.83 to 1.26; 2 trials, 60,480 children; very low-certainty evidence) and under-five mortality (HR 1.18, 95% CI 1.01 to 1.37; 1 trial, 4729 children; very low-certainty evidence). iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness by 68% (RR 1.68, 95% CI 1.24 to 2.27; 2 trials, 9853 children; moderate-certainty evidence). None of the studies reported quality of care, severity of illness or adverse events for this comparison. When compared to usual facility services plus CCM for malaria, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (very low-certainty evidence) and iCCM may have little or no effect on careseeking to an appropriate provider for any iCCM illness (RR 1.06, 95% CI 0.97 to 1.17; 1 trial, 811 children; low-certainty evidence). None of the studies reported quality of care, case load or severity of illness at health facilities, mortality or adverse events for this comparison. AUTHORS' CONCLUSIONS: iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde da Criança/organização & administração , Agentes Comunitários de Saúde , Países em Desenvolvimento , África ao Sul do Saara , Ásia , Viés , Pré-Escolar , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/organização & administração , Estudos Controlados Antes e Depois , Diarreia/terapia , Febre/terapia , Humanos , Lactente , Mortalidade Infantil , Transtornos da Nutrição do Lactente/terapia , Recém-Nascido , Malária/terapia , Sepse Neonatal/terapia , Pneumonia/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Salários e Benefícios , Nações Unidas
10.
Health Secur ; 19(1): 44-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33606572

RESUMO

Misinformation about coronavirus disease 2019 (COVID-19) is a significant threat to global public health because it can inadvertently exacerbate public health challenges by promoting spread of the disease. This study used a convenience sampling technique to examine factors associated with misinformation about COVID-19 in sub-Saharan Africa using an online cross-sectional survey. A link to the online self-administered questionnaire was distributed to 1,969 participants through social media platforms and the authors' email networks. Four false statements-informed by results from a pilot study-were included in the survey. The participants' responses were classified as "Agree," "Neutral," and "Disagree." A multinomial logistic regression was used to examine associated factors. Among those who responded to the survey, 19.3% believed that COVID-19 was designed to reduce world population, 22.2% thought the ability to hold your breath for 10 seconds meant that you do not have COVID-19, 27.8% believed drinking hot water flushes down the virus, and 13.9% thought that COVID-19 had little effect on Blacks compared with Whites. An average of 33.7% were unsure whether the 4 false statements were true. Multivariate analysis revealed that those who thought COVID-19 was unlikely to continue in their countries reported higher odds of believing in these 4 false statements. Other significant factors associated with belief in misinformation were age (older adults), employment status (unemployed), gender (female), education (bachelor's degree), and knowledge about the main clinical symptoms of COVID-19. Strategies to reduce the spread of false information about COVID-19 and other future pandemics should target these subpopulations, especially those with limited education. This will also enhance compliance with public health measures to reduce spread of further outbreaks.


Assuntos
Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Adulto , África ao Sul do Saara , Fatores Etários , Estudos Transversais , Escolaridade , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
Niger J Clin Pract ; 24(2): 148-155, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33605902

RESUMO

The National Surgical Obstetric and Anaesthesia Plan is an invaluable country resource with the capacity to promote increased access to safe and affordable surgical and anaesthesia care if implemented. Although cost of implementation is only a fraction of Health Sector Strategic Plan cost in the countries with costed plans, it is important that the funding of the plans is based on sustainable financing strategies. This will ensure appropriate and timely implementation and sustainability of the plan itself. The aim of this review was to discuss and make recommendations on innovative and sustainable strategies for financing national surgical plans in sub-Saharan Africa.


Assuntos
Custos de Cuidados de Saúde , Cobertura Universal do Seguro de Saúde , África ao Sul do Saara , Feminino , Humanos , Gravidez
13.
BMC Health Serv Res ; 21(1): 22, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407442

RESUMO

BACKGROUND: In sub-Saharan Africa, there is dearth of trained laboratorians and strengthened laboratory systems to provide adequate and quality laboratory services for enhanced HIV control. In response to this challenge, in 2007, the African Centre for Integrated Laboratory Training (ACILT) was established in South Africa with a mission to train staffs from countries with high burdens of diseases in skills needed to strengthen sustainable laboratory systems. This study was undertaken to assess the transference of newly gained knowledge and skills to other laboratory staff, and to identify enabling and obstructive factors to their implementation. METHODS: We used Kirkpatrick model to determine training effectiveness by assessing the transference of newly gained knowledge and skills to participant's work environment, along with measuring enabling and obstructive factors. In addition to regular course evaluations at ACILT (pre and post training), in 2015 we sent e-questionnaires to 867 participants in 43 countries for course participation between 2008 and 2014. Diagnostics courses included Viral Load, and systems strengthening included strategic planning and Biosafety and Biosecurity. SAS v9.44 and Excel were used to analyze retrospective de-identified data collected at six months pre and post-training. RESULTS: Of the 867 participants, 203 (23.4%) responded and reported average improvements in accuracy and timeliness in Viral Load programs and to systems strengthening. For Viral Load testing, frequency of corrective action for unsatisfactory proficiency scores improved from 57 to 91%, testing error rates reduced from 12.9% to 4.9%; 88% responders contributed to the first national strategic plan development and 91% developed strategies to mitigate biosafety risks in their institutions. Key enabling factors were team and management support, and key obstructive factors included insufficient resources and staff's resistance to change. CONCLUSIONS: Training at ACILT had a documented positive impact on strengthening the laboratory capacity and laboratory workforce and substantial cost savings. ACILT's investment produced a multiplier effect whereby national laboratory systems, personnel and leadership reaped training benefits. This laboratory training centre with a global clientele contributed to improve existing laboratory services, systems and networks for the HIV epidemic and is now being leveraged for COVID-19 testing that has infected 41,332,899 people globally.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Laboratórios/organização & administração , Pessoal de Laboratório/educação , África ao Sul do Saara/epidemiologia , Serviços de Laboratório Clínico , Infecções por HIV/epidemiologia , Pesquisa sobre Serviços de Saúde , Humanos , Estudos Retrospectivos
14.
New Microbiol ; 44(1): 62-65, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33453705

RESUMO

Serology is the most sensitive test for the diagnosis of schistosomiasis and strongyloidiasis, highly prevalent diseases in Sub-Saharan Africa (SSA). The collection of dried blood spots (DBS) on filter papers enables researchers to conduct community-based studies on this matter. We investigated the seroprevalence of schistosomiasis and strongyloidiasis on DBS in SSA migrants recently arrived in Italy. Seroprevalence was 10.2% for schistosomiasis and 2.7% for strongyloidiasis. The association between symptoms and positive serology was not statistically significant. Community-based serological screening of SSA migrants by means of DBS seems feasible and accepted; screening should be conducted independently of the presence of symptoms in such population.


Assuntos
Esquistossomose , Estrongiloidíase , Migrantes , África ao Sul do Saara/epidemiologia , Teste em Amostras de Sangue Seco , Humanos , Itália/epidemiologia , Esquistossomose/epidemiologia , Estudos Soroepidemiológicos , Estrongiloidíase/diagnóstico , Estrongiloidíase/epidemiologia
15.
Nature ; 589(7843): 554-561, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33505037

RESUMO

Historically, human uses of land have transformed and fragmented ecosystems1,2, degraded biodiversity3,4, disrupted carbon and nitrogen cycles5,6 and added prodigious quantities of greenhouse gases (GHGs) to the atmosphere7,8. However, in contrast to fossil-fuel carbon dioxide (CO2) emissions, trends and drivers of GHG emissions from land management and land-use change (together referred to as 'land-use emissions') have not been as comprehensively and systematically assessed. Here we present country-, process-, GHG- and product-specific inventories of global land-use emissions from 1961 to 2017, we decompose key demographic, economic and technical drivers of emissions and we assess the uncertainties and the sensitivity of results to different accounting assumptions. Despite steady increases in population (+144 per cent) and agricultural production per capita (+58 per cent), as well as smaller increases in emissions per land area used (+8 per cent), decreases in land required per unit of agricultural production (-70 per cent) kept global annual land-use emissions relatively constant at about 11 gigatonnes CO2-equivalent until 2001. After 2001, driven by rising emissions per land area, emissions increased by 2.4 gigatonnes CO2-equivalent per decade to 14.6 gigatonnes CO2-equivalent in 2017 (about 25 per cent of total anthropogenic GHG emissions). Although emissions intensity decreased in all regions, large differences across regions persist over time. The three highest-emitting regions (Latin America, Southeast Asia and sub-Saharan Africa) dominate global emissions growth from 1961 to 2017, driven by rapid and extensive growth of agricultural production and related land-use change. In addition, disproportionate emissions are related to certain products: beef and a few other red meats supply only 1 per cent of calories worldwide, but account for 25 per cent of all land-use emissions. Even where land-use change emissions are negligible or negative, total per capita CO2-equivalent land-use emissions remain near 0.5 tonnes per capita, suggesting the current frontier of mitigation efforts. Our results are consistent with existing knowledge-for example, on the role of population and economic growth and dietary choice-but provide additional insight into regional and sectoral trends.


Assuntos
Agricultura/estatística & dados numéricos , Dióxido de Carbono/análise , Combustíveis Fósseis , Atividades Humanas , Internacionalidade , Metano/análise , Óxido Nitroso/análise , África ao Sul do Saara , Animais , Ásia Sudeste , Produtos Agrícolas/provisão & distribução , Grão Comestível/provisão & distribução , Mapeamento Geográfico , História do Século XX , História do Século XXI , América Latina , Esterco , Oryza , Carne Vermelha/provisão & distribução , Solo , Desenvolvimento Sustentável/tendências , Madeira
16.
AIDS ; 35(2): 227-234, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33394670

RESUMO

OBJECTIVES: HIV-1 pretreatment drug resistance (PDR) is a global concern. Our aim was to evaluate high-throughput sequencing (HTS) for HIV-1 resistance testing and describe PDR in Sweden, where 75% of diagnosed individuals are foreign-born. DESIGN: Cross-sectional study. METHODS: Individuals entering HIV-1 care in Sweden 2017 to March 2019 (n = 400) were included if a viremic sample was available (n = 220). HTS was performed using an in-house assay. Drug resistance mutations (DRMs) (based on Stanford HIV DB vs. 8.7) at levels 1-5%, 5-19% and at least 20% of the viral population were described. Results from HTS and routine Sanger sequencing were compared. RESULTS: HTS was successful in 88% of patients, 92% when viral load was at least 1000 copies/ml. DRMs at any level in protease and/or reverse transcriptase were detected in 95 individuals (49%), whereas DRMs at least 20% in 35 (18%) individuals. DRMs at least 20% correlated well to findings in routine Sanger sequencing. Protease/reverse transcriptase (PR/RT) DRMs at least 20% were predicted by treatment exposure; adjusted OR 9.28 (95% CI 2.24-38.43; P = 0.002) and origin in Asia; adjusted OR 20.65 (95% CI 1.66-256.24; P = 0.02). Nonnucleoside reverse transcriptase inhibitor (NNRTI) DRMs at least 20% were common (16%) and over-represented in individuals originating from sub-Saharan Africa or Asia. Low-level integrase strand transfer inhibitor (INSTI) DRMs less than 20% were detected in 15 individuals (8%) with no association with INSTI exposure. CONCLUSION: Our HTS can efficiently detect PDR and findings of DRMs at least 20% compare well to routine Sanger sequencing. The high prevalence of PDR was because of NNRTI DRMs and associated with migration from areas with emerging PDR.


Assuntos
Fármacos Anti-HIV , Farmacorresistência Viral , Infecções por HIV , HIV-1 , África ao Sul do Saara , Fármacos Anti-HIV/uso terapêutico , Ásia , Estudos Transversais , Genótipo , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Mutação/efeitos dos fármacos , Prevalência , Suécia/epidemiologia
17.
AIDS ; 35(2): 287-297, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33394672

RESUMO

BACKGROUND: Early infant diagnosis of HIV (EID) improves child survival through earlier initiation of antiretroviral therapy (ART). In many settings, ART initiation is hindered by delays in testing performed in centralized labs. Point-of-care (PoC) platforms offer opportunities to improve the timeliness of ART initiation. METHODS: We used a mathematical model to estimate the costs and performance of on-site PoC testing using three platforms (m-PIMA, GeneXpert IV, and GeneXpert Edge) compared with the standard of care (SoC). Primary outcomes included ART initiation within 60 days of sample collection, HIV-related mortality before ART initiation, and incremental cost-effectiveness ratios (ICERs). RESULTS: PoC testing significantly increased ART initiation within 60 days (from 19% with SoC to 82-84% with PoC) and decreased HIV-related mortality (from 23% with SoC to 5% with PoC). ART initiation and mortality were similar across PoC platforms. When only used for EID and with high coverage of prevention of mother-to-child transmission (PMTCT) programs, ICERs for PoC testing compared with the SoC ranged from $430 to $1097 per additional infant on ART within 60 days and from $1527 to $3888 per death averted. PoC-based testing was more cost-effective in settings with lower PMTCT coverage, greater delays in the SoC, and when PoC instruments could be integrated with other disease programs. CONCLUSION: Our findings illustrate that PoC platforms can dramatically improve the timeliness of EID and linkage to HIV care. The cost-effectiveness of PoC platforms depends on the cost of PoC testing, existing access to diagnostic testing, and the ability to integrate PoC testing with non-EID programs.


Assuntos
Infecções por HIV , Sistemas Automatizados de Assistência Junto ao Leito , África ao Sul do Saara , Criança , Análise Custo-Benefício , Diagnóstico Precoce , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Testes Imediatos
19.
West Afr J Med ; 38(1): 75-79, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33463711

RESUMO

BACKGROUND: Education at the postgraduate level is important in grooming competent specialists in different fields of surgical care. This study aimed to evaluate the training experience, professional satisfaction, and personal well-being of postgraduate surgical residents in northern Nigeria. SUBJECTS, MATERIALS AND METHODS: It was a cross-sectional survey of 157 medical doctors enrolled for a minimum of 6 months in surgical residency training in tertiary hospitals in the northern zone of the country. All participants filled a pre-tested questionnaire and their responses were analyzed using Statistical Package for the Social Sciences version 20. RESULTS: The respondents had a mean age of 34.4 ± 4.8 years. Thirty-two (20.5%) agreed that there was a balance between their training needs and rotation for clinical services. There was a marked disparity between the median time allocated for non-ward-based training activities (4.0 hours each per week) and the average time allocated for research activities (1.0 hours per week). Although 89 (57.4%) and 82 (53.3%) reported fair satisfaction in their professional role and private life respectively, a larger proportion expressed poor satisfaction with their participation in recreational (107 [68.6%]) and social activities (90 [58.4%]). One hundred and seventeen (74.5%) stated that a high level of stress was associated with their training. CONCLUSIONS: The surgical residents experienced relatively more training on patient management than on research work. Although their educational experience was associated with a high level of stress in majority of them, most of the trainees expressed fair satisfaction with activities in their professional role and private life.


Assuntos
Cirurgia Geral , Internato e Residência , Satisfação Pessoal , Estudantes de Medicina , Adulto , África ao Sul do Saara , Estudos Transversais , Cirurgia Geral/educação , Humanos , Nigéria , Inquéritos e Questionários
20.
BMJ Glob Health ; 6(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33419929

RESUMO

In-person interactions have traditionally been the gold standard for qualitative data collection. The COVID-19 pandemic required researchers to consider if remote data collection can meet research objectives, while retaining the same level of data quality and participant protections. We use four case studies from the Philippines, Zambia, India and Uganda to assess the challenges and opportunities of remote data collection during COVID-19. We present lessons learned that may inform practice in similar settings, as well as reflections for the field of qualitative inquiry in the post-COVID-19 era. Key challenges and strategies to overcome them included the need for adapted researcher training in the use of technologies and consent procedures, preparation for abbreviated interviews due to connectivity concerns, and the adoption of regular researcher debriefings. Participant outreach to allay suspicions ranged from communicating study information through multiple channels to highlighting associations with local institutions to boost credibility. Interviews were largely successful, and contained a meaningful level of depth, nuance and conviction that allowed teams to meet study objectives. Rapport still benefitted from conventional interviewer skills, including attentiveness and fluency with interview guides. While differently abled populations may encounter different barriers, the included case studies, which varied in geography and aims, all experienced more rapid recruitment and robust enrollment. Reduced in-person travel lowered interview costs and increased participation among groups who may not have otherwise attended. In our view, remote data collection is not a replacement for in-person endeavours, but a highly beneficial complement. It may increase accessibility and equity in participant contributions and lower costs, while maintaining rich data collection in multiple study target populations and settings.


Assuntos
Coleta de Dados , Relações Interpessoais , África ao Sul do Saara , Confiabilidade dos Dados , Coleta de Dados/métodos , Coleta de Dados/normas , Humanos , Índia , Internet , Pandemias , Filipinas , Pesquisa Qualitativa
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