Looking Beyond the Lens of Crimean-Congo Hemorrhagic Fever in Africa.

Crimean-Congo hemorrhagic fever (CCHF) is a lethal viral disease that has severe public health effects throughout Africa and a case fatality rate of 10%-40%. CCHF virus was first discovered in Crimea in 1944 and has since caused a substantial disease burden in Africa. The shortage of diagnostic tools, ineffective tick control efforts, slow adoption of preventive measures, and cultural hurdles to public education are among the problems associated with continued CCHF virus transmission. Progress in preventing virus spread is also hampered by the dearth of effective serodiagnostic testing for animals and absence of precise surveillance protocols. Intergovernmental coordination, creation of regional reference laboratories, multiinstitutional public education partnerships, investments in healthcare infrastructure, vaccine development, and a One Health approach are strategic methods for solving prevention challenges. Coordinated efforts and financial commitments are needed to combat Crimean-Congo hemorrhagic fever and improve all-around readiness for newly developing infectious illnesses in Africa.

Intriguing insight into unanswered questions about Mpox: exploring health policy implications and considerations.

The 2022 multi-country Monkeypox (Mpox) outbreak has added concerns to scientific research. However, unanswered questions about the disease remain. These unanswered questions lie in different aspects, such as transmission, the affected community, clinical presentations, infection and prevention control and treatment and vaccination. It is imperative to address these issues to stop the spread and transmission of disease. We documented unanswered questions with Mpox and offered suggestions that could help put health policy into practice. One of those questions is why gay, bisexual or other men who have sex with men (gbMSM) are the most affected community, underscoring the importance of prioritizing this community regarding treatment, vaccination and post-exposure prophylaxis. In addition, destigmatizing gbMSM and implementing community-based gbMSM consultation and action alongside ethical surveillance can facilitate other preventive measures such as ring vaccination to curb disease transmission and track vaccine efficacy. Relevant to that, vaccine and drug side effects have implied the questionability of their use and stimulated the importance of health policy development regarding expanded access and off-label use, expressing the need for safe drug and vaccine development manufacturing. The possibility of reverse zoonotic has also been raised, thus indicating the requirement to screen not only humans, but also their related animals to understand the real magnitude of reverse zoonosis and its potential risks. Implementing infection prevention and control measures to stop the virus circulation at the human-animal interface that includes One Health approach is essential.

Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study.

BACKGROUND: Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. METHODS: A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. RESULTS: This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. CONCLUSIONS: Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.

The efficacy of intrauterine infusion of platelet rich plasma in women undergoing assisted reproduction: a systematic review and meta-analysis.

BACKGROUND: Platelet-rich plasma (PRP) is an autologous platelet concentration recently used in the reproductive field. Studies had conflicting results regarding its effect on pregnancy outcomes. We aimed to solve the debate on the safety and efficacy of PRP in women undergoing assisted reproduction and assess the influence of covariates on the outcomes of PRP infusion. METHODS: We searched PubMed, Scopus, Cochrane, and Web of Science in May 2023. We included randomized and non-randomized clinical trials as well as cohort studies assessing intrauterine PRP in sub fertile women undergoing assisted reproduction (IVF/ICSI). For the quality assessment, We used the Cochrane Risk of Bias Tool 1, the ROBINS-I tool, and the Newcastle-Ottawa Scale. We pooled the data using RevMan version 5.4. RESULTS: The data from 23 studies were pooled. PRP had favorable outcomes compared with the control group on clinical pregnancy rate (RR: 1.84, 95% CI 1.62 to 2.09; P < 0.00001), live birth rate (RR: 1.75, 95% CI: 1.24 to 2.47; P = 0.001), and miscarriages (RR: 0.51, 95% CI: 0.36 to 0.72; P = 0.0002). Women with repeated implantation failure had a significantly improved clinical pregnancy rate (RR: 1.83, 95% CI: 1.49 to 2.24; P < 0.00001), live birth rate (RR:1.83, 95% CI: 1.33 to 2.51; P = 0.002), and miscarriage rate (RR: 0.46, 95% CI: 0.31 to 068; P = 0.0001). CONCLUSION: PRP showed promising results in assisted reproductive techniques. Further large and multicenter RCTs are required to compare the doses of PRP while identifying the specific population with the most benefits from PRP.

An OxPLORE Initiative Evaluating Children's Surgery Resources Worldwide: A Cross-sectional Implementation of the OReCS Document.

BACKGROUND: The Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children's Surgery (OReCS) document in 2019, listing standards of children's surgical care by level of healthcare facilities within low resource settings. We have previously created and piloted an audit tool based on the OReCS criteria in a high-income setting. In this study, we aimed to validate its use in identifying gaps in children's surgery provision worldwide. METHODS: Our OReCS audit tool was implemented in 10 hospitals providing children's surgery across eight countries. Collaborators were recruited via the Oxford Paediatrics Linking Our Research with Electives (OxPLORE) international network of medical students and trainees. The audit tool measured a hospital's current capacity for children's surgery. Data were analysed firstly to express the percentage of 'essential' criteria met for each specialty. Secondly, the 'OxPLORE method' was used to allocate each hospital specialty a level based on procedures performed and resources available. A User Evaluation Tool (UET) was developed to obtain feedback on the ease of use of the tool. RESULTS: The percentage of essential criteria met within each category varied widely between hospitals. The level given to hospitals for subspecialties based on OReCS criteria often did not reflect their self-defined level. The UET indicated the audit tool was practicable across multiple settings. CONCLUSIONS: We recommend the use of the OReCS criteria to identify areas for local hospital improvement and inform national children's surgical plans. We have made informed suggestions to increase usability of the OReCS audit tool.

Impact of the COVID-19 pandemic on the food rations of refugees in Rwanda.

The coronavirus disease (COVID-19) has significantly impacted the global economy, by forcing people to stay indoors and creating a 'new normal' of living. Rwanda has made notable efforts to fight the pandemic. However, the impacts of the COVID-19 pandemic on the country's economy are numerous and the refugees residing in Rwanda are not spared these effects. As of December 2020, 164,000 people were granted refugee status in Rwanda according to the United Nations High Commissioner for Refugees (UNHCR). The majority were from neighbouring countries in the Great Lakes regions, including DRC (Democratic Republic of Congo) and Burundi. The impact the COVID-19 pandemic on the global economy has led to a decline in donations to the United Nations World Food Programme (WFP), which in turn has significantly reduced the food rations of refugees. Such paucity will no doubt cause unprecedented impacts on the people residing in refugee camps, who completely depend on humanitarian aid to meet their basic food requirements. This lack of access to adequate and affordable food will expose refugees to extreme hunger and starvation, putting their lives in danger by triggering forced returns, infections, social conflicts and thus higher morbidity and mortality.Furthermore, such stressful environments would no doubt put the mental health of these already vulnerable communities at risk. It is unsurprising that refugees are more likely to experience poor mental health compared to local population, including higher rates of depression and anxiety disorders including Post-Traumatic Stress Disorder (PTSD). This is an issue as they are also less likely to receive support than the general population. Refugees in Rwanda are under the responsibility of UNHCR and WFP, who should ensure adequate food assistance is provided to refugees and therefore ameliorate the risks to health that result from food shortages, safeguarding these vulnerable communities.

Transforming adolescent menstrual health through policy: the role of value added tax exemptions in improving access to sanitary products.

In Namibia, the Value Added Tax (VAT) Amendment Act 2022, which reclassified the supply of sanitary pads as zero-rated, has significant implications for adolescent girls' menstrual health and education. The policy change responds to the need to address period poverty by making essential menstrual products more accessible and affordable. Menstruation is a normal biological process, and access to sanitary products is a human right. Taxing menstrual products reinforces gender inequalities and raises concerns about the basic rights and dignity of women and girls. The VAT-free policy creates a system to reduce the financial burden on girls and women, making it easier for them to manage their periods safely and with dignity. It has the potential to reduce absenteeism from school, ultimately improving educational outcomes for adolescent girls. However, VAT exemptions alone are insufficient to address the broader accessibility issues that impact menstrual hygiene. Evidence-based policies that focus on the availability and affordability of a full range of sanitary products, in conjunction with regulatory mechanisms for price and quality control, are necessary to ensure that menstrual products are safe, affordable, and accessible for all.

Cabo Verde's malaria-free certification: A blueprint for eradicating malaria in Africa.

The World Health Organisation (WHO) officially certified Cabo Verde as a malaria-free country in January 2024, marking a key milestone in world health and demonstrating the efficacy of comprehensive malaria control programs. Cabo Verde is only the third country in the WHO African region to have achieved this designation, highlighting the potential for other nations to successfully eradicate malaria. Despite encountering hurdles like drug-resistant strains and COVID-19 disruptions, Cabo Verde's success after years of strategic planning and multisectoral collaboration highlights the value of long-term public health initiatives. To emulate this achievement, African countries must take a holistic approach that includes strong leadership, effective monitoring systems, and community engagement. Leveraging current resources and embracing breakthroughs, such as the recent introduction of malaria vaccinations, will be critical to achieving a malaria-free Africa. Countries that integrate socioeconomic development into malaria eradication efforts might reduce the burden of malaria on vulnerable communities while also driving progress towards larger development goals. Cabo Verde's success serves as an example of the continent's malaria fight, emphasizing the significance of long-term vigilance, adaptability, and collaborative action in realizing a common goal of a malaria-free future.

Cholera resurgence in Africa: assessing progress, challenges, and public health response towards the 2030 global elimination target.

Global efforts to combat epidemic cholera outbreaks have witnessed tremendous feats over the decades. However, sporadic outbreaks in regions, particularly across African states, mask these advancements. This regressive trend is frequently fuelled by factors retarding efforts towards optimal environmental sanitation and personal hygiene, which include ingesting infected food, drinking contaminated waters, and engaging in unhealthy environmental practices such as indiscriminate waste and sewage disposal and poor toilet practices. The ongoing efforts to achieve the Global Taskforce on Cholera Control (GTFCC) targets of a 90% reduction in cases and deaths by 2030, even in the wake of continuous outbreaks across various African regions, as reported by the World Health Organization (WHO) face a significant threat. One such effort, among others, is the AFRICHOL project, an enhanced cholera surveillance consortium launched in Africa over a decade ago as part of the GTFCC at WHO to monitor and fast-track the GTFCC's 2030 targets. It is tasked with supporting the implementation of research-based strategies for combating cholera in Africa. The prequalified oral cholera vaccines - Dukoral, Shanchol, and Euvichol - and those with recombinant DNA technology have also emerged as remarkable strides. In the face of this progress, challenges persist. Climate change, including extreme weather events and the lack of safe water, sanitation, and hygiene facilities, acts as a multiplier, amplifying existing challenges and hindering progress. Porous borders with inefficient disease surveillance networks among member states also facilitate the inter-territorial spread of the disease. Despite ongoing challenges, global targets are achievable provided strong institutional infrastructure and additional evidence-based public health initiatives are promulgated and enacted. The Global Roadmap to Ending Cholera Outbreaks by 2030 is a resourceful tool for advancing this fight and eradicating cholera.

Fear in general populations: A cross-sectional study on perceived fear of common diseases, COVID-19, life events, and environmental threats in 30 countries.

Background: In this study, we assessed the general population's fears towards various diseases and events, aiming to inform public health strategies that balance health-seeking behaviours. Methods: We surveyed adults from 30 countries across all World Health Organization (WHO) regions between July 2020 and August 2021. Participants rated their fear of 11 factors on an 11-point Likert scale. We stratified the data by age and gender and examined variations across countries and regions through multidimensional preference analysis. Results: Of the 16 512 adult participants, 62.7% (n = 10 351) were women. The most feared factor was the loss of family members, reported by 4232 participants (25.9%), followed by cancer (n = 2248, 13.7%) and stroke (n = 1416, 8.7%). The highest weighted fear scores were for loss of family members (mean (x̄) = 7.46, standard deviation (SD) = 3.04), cancer (x̄ = 7.00, SD = 3.09), and stroke (x̄ = 6.61, SD = 3.24). The least feared factors included animals/insects (x̄ = 3.72, SD = 2.96), loss of a mobile phone (x̄ = 4.27, SD = 2.98), and social isolation (x̄ = 4.83, SD = 3.13). Coronavirus disease 2019 (COVID-19) was the sixth most feared factor (x̄ = 6.23, SD = 2.92). Multidimensional preference analyses showed distinct fears of COVID-19 and job loss in Australia and Burundi. The other countries primarily feared loss of family members, cancer, stroke, and heart attacks; this ranking was consistent across WHO regions, economic levels, and COVID-19 severity levels. Conclusions: Fear of family loss can improve public health messaging, highlighting the need for bereavement support and the prevention of early death-causing diseases. Addressing cancer fears is crucial to encouraging the use of preventive services. Fear of non-communicable diseases remains high during health emergencies. Top fears require more resources and countries with similar concerns should collaborate internationally for effective fear management.

Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Monkeypox virus declared as a global health emergency: What next for Africa's preparedness?

The Monkeypox virus, declared a global emergency outbreak, has garnered increasing response globally. The African healthcare community has not translated urgency in its response to the increasing outbreak. The multisectoral influence of COVID-19 has ensured that response patterns to the emerging outbreak must hold ground for proactiveness. The push for stronger health systems reiterated with the COVID-19 pandemic ensures that a successful response requires awareness of knowledge management, multisectoral and international collaboration and strengthening of systems capacity. The intricacies of the infection transmission ensure that interventions must promote equity and justice as well as financial protection of the population.

Healthcare workers and monkeypox: The case for risk mitigation.

Potentially more at risk of contracting the monkeypox virus are healthcare workers. Most healthcare workers come into direct contact with the disease's infected people, which can spread directly and indirectly. Healthcare professionals must contact patients with the disease and any infected objects or fluids to effectively manage the disease, which further increases the risk of transmission. It is crucial to put safety measures in place and protect healthcare workers. To stop the spread of the monkeypox virus, countries must develop the necessary safeguards and countermeasures. In this emergency, healthcare systems must be strengthened. All healthcare systems should offer staff sufficient personal protective equipment (PPE) and facilitate risk assessment among those with a high risk of exposure. Any suspected case of monkeypox requires caution on the part of healthcare professionals. They must abide by infection control safety rules and protective measures.

The emergence of BtSY2 Covid-like virus: A call for global preparedness.

Scientists in China announced on 25th of November with great concern that there is a new Covid-like virus out of the five viruses of concern discovered among bats across Yunnan province. It was reported that this Covid-like virus BtSY2 has high potential of infecting humans as it comprises a receptor binding domain which is a vital part of the spike protein used to lay hold of human cells and subsequently utilize human ACE2 receptor for cell entry similar to the SARS-CoV-2. In a bid to address this global threat in affected countries, it is expedient for authorized health professionals, policy makers and the world to keep an eye on this Covid-like virus capable of spreading from bats to humans because most pandemic outbreaks in recent decades have arisen in such a manner. Strict actions should be implemented in impeding transmission to humans which is paramount to battling viral diseases as learnt from history that viral outbreaks are very impossible to eradicate after global outbreak. Health officials and the World Health Organization should invest urgently in more research to further study this new Covid-like virus with an approach to prepare for a possible viral outbreak, and develop treatment options and possible vaccines to outsmart the danger posed to human health.

Paucity of Health Data in Africa: An Obstacle to Digital Health Implementation and Evidence-Based Practice.

Background: Among the numerous challenges that Africa faces in improving its healthcare systems, the paucity of health data stands out as paramount. This study aims to examine the challenges related to the paucity of health data in Africa and its impact on the implementation of digital health and evidence-based practice. The findings of the study reveal that health data availability in Africa is both limited and frequently of poor quality. Several factors contribute to this concerning situation, encompassing inadequate infrastructure, a shortage of resources, and cultural barriers. Furthermore, the available data, despite its limitations, is often underutilized due to a lack of capacity and expertise in data analysis and interpretation. Policy Options and Recommendations: To improve healthcare delivery in Africa, we recommend implementing novel strategies for data collection. It's important to recognize that effective information technology service is crucial for enhancing healthcare delivery, and a holistic approach is necessary to achieve this. Conclusion: This brief presents information to help policymakers develop long-term solutions to Africa's health data poverty. Taking action based on this evidence can assist in addressing the problem.

Monkeypox vaccination in the global south: Fighting a war without a weapon.

Background: The Mpox outbreak awakened countries worldwide to renew efforts in epidemiological surveillance and vaccination of susceptible populations. In terms of Mpox vaccination, various challenges exist in the global south, which impede adequate vaccine coverage, especially in Africa. This paper reviewed the situation of Mpox vaccination in the global south and potential ameliorative approaches. Methods: A review of online literature from PubMed and Google Scholar concerning Mpox vaccination in countries belonging to the 'global south' category was done between August and September, 2022. The major focus areas included inequity in global vaccine distribution, challenges impeding vaccine coverage in the global south, and potential strategies for bridging the gap in vaccine equity. The papers that met the inclusion criteria were collated and narratively discussed. Results: Our analysis revealed that, while the high-income countries secured large supplies of the Mpox vaccines, the low- and middle-income countries were unable to independently access substantial quantities of the vaccine and had to rely on vaccine donations from high-income countries, as was the case during the COVID-19 pandemic. The challenges in the global south particularly revolved around inadequate vaccine production capacity due to lack of qualified personnel and specialized infrastructure for full vaccine development and manufacturing, limited cold chain equipment for vaccine distribution, and consistent vaccine hesitancy. Conclusion: To tackle the trend of vaccine inequity in the global south, African governments and international stakeholders must invest properly in adequate production and dissemination of Mpox vaccines in low- and middle-income countries.

Synergistic fight against future pandemics: Lessons from previous pandemics.

The history of pandemics spans centuries and has had a profound impact on human health, societies, and economies. Pandemics have caused fear, panic, and significant morbidity and mortality rates throughout history. From the Athenian Plague in 430 BC to the ongoing COVID-19 pandemic, infectious diseases have posed a continuous threat to global health systems. The transition from hunter-gatherer societies to agrarian communities, increased trade and interaction between humans and animals, urbanization, travel rates, and the impact of a growing human population have all contributed to the emergence and spread of infectious diseases. Climate change and changes in land use further affect the transmission of pathogens and the distribution of disease-carrying vectors. Lessons from previous pandemics include the importance of early diagnosis and response, global cooperation and collaboration, strengthened healthcare systems, preparedness planning, public health education and communication, research and development, and adaptability and flexibility in response strategies. These lessons emphasize the significance of timely identification, swift action, sharing information and resources, investing in healthcare infrastructure, preparedness planning, effective communication, research advancements, and the ability to adapt measures as pandemics evolve. In addition, the COVID-19 pandemic has reinforced the need for a collaborative and coordinated global response to future pandemics. Governments, international bodies, healthcare organizations, and individuals could learn from the lessons of the past and apply them effectively to combat and mitigate the impact of future outbreaks. By prioritizing all the recommendations stated, the world can synergistically protect public health and minimize the devastating consequences of pandemics.

The Re-emergence of Diphtheria Amidst Multiple Outbreaks in Nigeria.

Diphtheria, a vaccine-preventable disease, has resurfaced in Nigeria, where many outbreaks have been reported in recent years. The outbreaks have occurred across the country, including in areas with high vaccination coverage. Corynebacterium diphtheriae, the causal agent, is a highly contagious bacteria that can cause severe respiratory and systemic symptoms and can be fatal if not treated. The reemergence of diphtheria in Nigeria is most likely due to a combination of factors, including gaps in routine immunization regimens. The outbreak is further aggravated by multiple epidemics, which have diverted resources and attention away from the emergency of other infectious diseases. Furthermore, there is a lack of awareness of diphtheria in Nigeria. With a focus on the difficulties in controlling the disease, methods of diagnosis, available treatments, and preventive measures, this study provides a thorough analysis of diphtheria, covering its historical context, clinical presentation, associated complications, and current outbreaks. It emphasizes how important vaccination, early detection, and better access to healthcare are in reducing diphtheria outbreaks. The study highlights the serious effects of diphtheria on public health, particularly in regions with scarce resources and vaccine resistance, and offers a number of suggestions to overcome these challenges and prevent further outbreaks.