Human resources for health governance and leadership strategies for improving health outcomes in low- and middle-income countries: a narrative review.

BACKGROUND: Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis. METHODS: Selected electronic databases were searched up until 30 May 2020. Two authors screened studies independently and extracted data from included studies. Quality assessment was done using the Mixed Methods Appraisal Tool. Thematic analysis of the outcomes was done. RESULTS: We included 18 studies of variable designs across Africa, Asia, South America and the Pacific islands. Most were case-based studies and were of moderate to high quality. Several governance strategies with a positive impact on the health workforce and health outcomes identified included decentralization, central coordination and facilitation process, posting and transfer policies as well as the setting up of human resource units. CONCLUSIONS: Governance and leadership strategies targeting the HRH crises in LMIC are variable, interdependent and complex. While some show benefits in improving health workforce outcomes, only a few have an impact on population health outcomes.

Assessing agreement of hemoglobin and three- fold conversion of hematocrit as methods for detecting anemia in children living in malaria-endemic areas of Calabar, Nigeria.

BACKGROUND: One of the major causes of anemia, defined as the reduction in the level of hemoglobin or red blood cells (RBCs) in the blood, in children in sub-Saharan Africa is malaria. Anemia is diagnosed by using either the hematocrit method or by measuring the hemoglobin concentration. AIMS: To evaluate the relationship and agreement between hemoglobin and three-fold conversion of hematocrit results of participants in a clinical trial. MATERIALS AND METHODS: This is a cross-sectional study that obtained data from a multi-center clinical trial that took place from 2007 to 2008 in public health facilities in Calabar, Nigeria. The hemoglobin and hematocrit results of 494 children who had ≥2000 parasite density recruited were pooled to evaluate the relationship and agreement between the two methods. The difference between the measures against the mean of the two measures was plotted according to the theory of Bland and Altman. RESULTS: The mean age of the children was 34 months, with approximately equal number of boys and girls. The measured hemoglobin was lower than the calculated hemoglobin in 84.5% of the children. The result showed that lower the hemoglobin concentration, the higher the chances that the three-fold hematocrit conversion overestimates hemoglobin levels in the participants. CONCLUSIONS: The three-fold hematocrit conversion of hemoglobin estimation is a less reliable method than the measured hemoglobin in anemic children in the study setting.

Species Composition of Anopheles (Diptera: Culicidae) in Selected Forested Tourist Areas of Nigeria Endemic for Malaria.

The study was carried out to determine relative abundance, species diversity, of Anopheles species (Diptera: Culicidae) in selected forested areas in Cross River State, Nigeria and the prevalence of malaria infection in the specimens. Mosquitoes were collected using pyrethrum spray catch and Centre for Disease Control light traps modified with yeast and sugar to generate carbon dioxide (CO2) and identified using morphological identification keys. We used a multiplex polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) to simultaneously distinguish sibling species of the An. gambiae s.l, including separation of An. gambiae s.s. and An. coluzzii (Diptera: Culicidae). The samples were also screened for Plasmodium infection using the enzyme-linked immunosorbent assay. One hundred and four Anopheles specimens were collected during the study of which 97% was An. gambiae complex and 3% was An. rufipes (Diptera: Culicidae). Only 77% of the An. gambiae s.l. was identify to species level. The result shows that 41.6% was An. gambiae s.s. and 34.6% was An. coluzzii. No sporozoite of Plasmodium was detected in the Anopheles species. The study also found a hybrid form of An. gambiae s.s. and An. coluzzii. These findings suggest the first documented evidence of hybrid forms of An. gambiae s.s./An. coluzzii in South Eastern Nigeria although its epidemiological implication is still not clear.