Facilities In Africa Research Articles

COVID-19 and the call for ‘Safe Hands’: Challenges facing the under-resourced municipalities that lack potable water access - A case study of Chitungwiza municipality, Zimbabwe

Billions of people living in developing countries lack access to safe drinking water, not to mention water for handwashing, one of the most effective ways to contain the fast spreading novel coronavirus (COVID -19). The recent global spread of COVID-19 has fostered diverse initiatives such as the ‘Safe Hands’ challenge led by the World Health Organization. Individuals are encouraged to regularly wash their hands for 40–60 s under running water with soap. This call for ‘Safe Hands’ comes at a time when water insecurity and limited access to handwashing facilities in Africa is heightened. In this article, Chitungwiza city in Zimbabwe is used as a case study to assess the implications of the ‘Safe Hands’ challenge for poor municipalities in developing countries and characterize the challenges they face. To do so, interviews were conducted at water points/boreholes used by residents during Zimbabwe’s COVID-19 national lockdown. The calculation of water requirements for proper hand hygiene determined the capacity for water-stressed regions to effectively implement ‘Safe Hands’. On average, it was established that one person consumes an extra 4.5 L per day of water when they practice WHO ‘Safe Hands’ in the context of COVID-19. This increases domestic water demand in Chitungwiza by 9%. Due to water scarcity, people in Chitungwiza were experiencing challenges with practicing ‘Safe Hands’. With their ‘dry taps’ woes, they might not be able to meet the standards of this WHO challenge. Lack of soap also reduced the effectiveness of the ‘Safe Hands’ challenge. This paper proposes short- and long-term measures that would allow effective implementation of the ‘Safe Hands’ by means of sustainable potable water supply. These measures include extensive social awareness and temporary change of household water use behavior. Municipalities are recommended to establish public private partnerships (PPPs) to create immediate and long-term water investments. Structural and transformational reforms would enhance, through flexible planning, investments for both water infrastructure and governance. This narrative has the potential to improve the urban water systems resiliency against future pandemics.

Rural Healthcare Delivery in Sub-Saharan Africa

Access to quality healthcare is a major problem in Sub-Saharan Africa with a doctor-to-patient ratio as high as 1:50,000, which is far above the recommended ratio by the World Health Organization (WHO) which is 1:600. This has been aggravated by the lack of access to critical infrastructures such as the health care facilities, roads, electricity, and many other factors. Even if these infrastructures are provided, the number of medical practitioners to cater for the growing population of these countries is not sufficient. In this article, how information and communication technology (ICT) can be used to drive a sustainable health care delivery system through the introduction and promotion of Virtual Clinics and various health information systems such as mobile health and electronic health record systems into the healthcare industry in Sub-Saharan Africa is presented. Furthermore, the article suggests ways of attaining successful implementation of telemedicine applications /services and remote health care facilities in Africa.

Collaborative International Neurosurgery Education for Africa–The Journey So Far and the Way Forward

Lack of standard neurosurgical training has long been a major factor limiting the availability of neurosurgical services in most parts of Africa. International collaborative efforts have however, to a large extent, resolved this challenge. A review of previous international collaborative programs and educational initiatives in Africa along with their outcomes and accomplishments was conducted. We make a few recommendations on how these programs could be further improved upon toward more productivity and better output with the few available facilities in Africa. Various international collaborative programs focusing on neurosurgery education and training currently exist in East Africa with well-documented advancements in achieving their goals and especially include Neurosurgery Education and Development Foundation, the Weill Cornell Tanzania Neurosurgery project, Duke East Africa Neurosurgery Program, Duke Global Neurosurgery and Neurosciences, and CURE Hydrocephalus Program. In West Africa, they include the Swedish African Neurosurgical Collaboration and the Association of West African Neurosurgeons. So far, collaborative neurosurgical education and training has been an effective approach in efficiently and progressively increasing capacity in Africa. To further improve the quality of neurosurgical care in Africa in the face of difficult economic circumstances and significant neurosurgical disease burden, implementation of the suggested recommendations will enhance the capacity and sustainability of these existing programs with the few available facilities and equipment and would go a long way in further reducing the burden in Africa.

Determinants of Women Access to Healthcare Services in Sub-Saharan Africa

Background: The study examined the socio-economic determinants of women access to healthcare services in Sub-Saharan Africa for the period 1995-2015. Methods: The study adopted the dynamic panel model and estimated it using the System Generalized Method of Moments in a bid to overcome the endogeneity problem inherent in the model of study. Result: The study harmonized the theoretical strands in the literature by describing the measure of access determinants as three main components; i. Health service availability, ii. Health service utilization and iii. Health service decision. Conclusion: The indicators of health service availability such as community health workers, physicians, nurses and midwives and hospital beds improve women's access to healthcare facilities in Africa. Also, health service utilization indicators such as population density worsen the quality of healthcare services available to women while electricity access and private health expenditure enhance women’s access to quality healthcare delivery. Health service decision indicators such as female bank account ownership, female labour force participation, attainment of basic education and female household headship were important in enhancing women's access to healthcare facilities. Generally, women's health outcomes were more responsive to health service utilization; implying that service utilization is an important proof of healthcare access in Africa.

Radiotherapy treatment in cancer control and its important role in Africa.

Radiotherapy, although an essential and cost-effective treatment for cancer, has a low uptake on the African continent. Common cancers treated in the region need radiotherapy as a component of therapy at some point in the course of the management of their disease. Within Africa, around half of the countries have no radiotherapy services and most of those that have cannot adequately cover the population which needs them.To redress inequitable access, advocacy at all levels is needed for acceptance of radiotherapy and the important role it plays in cancer control. The relatively high cost of setting up radiotherapy services needs to be balanced with the long-term benefits of having a well-proven treatment modality that can be accessible to a large number of cancer patients at reasonable cost. Low healthcare funding in the region is a possible hindrance to access to radiotherapy.Consideration of the appropriateness of technology to be procured when setting up such facilities is important. It should not, however, be simply a case of gamma versus photon teletherapy. The level of training of staff, quality evidence-based treatment provision and infrastructural considerations need to be taken into account. Where facilities are available, low radiotherapy utilisation rates are common and should be corrected. Good practice regarding quality assurance is important. Local research to test regional and adopted practices should be promoted to provide local evidence.ConclusionsWith an imminent cancer epidemic, the scarcity of radiotherapy facilities in Africa is a cause for concern. The measures to correct this should include a multipronged approach that addresses specific needs for individual countries. Radiotherapy is an essential, cost-effective treatment for cancer and its availability must be given priority alongside the management interventions for other common diseases and conditions.

Advancing X-ray micro computed tomography in Africa: Going far, together

Abstract X-ray micro computed tomography (microCT) is a high resolution non-destructive materials imaging technology and is emerging as a powerful tool for industrial and scientific research applications. The aim of this review paper is to present the capabilities and potential of this technique within an African context. This is done using a representative sample: all work done at the Stellenbosch CT facility during 2018 is used as an overview of the type of work done at such a facility in Africa. Besides the plethora of academic research topics, the most important industrial applications are also discussed, which assisted to keep the Stellenbosch CT facility financially operational. This provides a wider understanding of the opportunities and capabilities of this technique and how it can benefit African researchers and local industries. The question “what is it used for?”, and more specifically “what is it used for in Africa?” is therefore answered. The availability of such X-ray tomography facilities helps to fast-track research by providing local expertise and support in Africa for advancing African science. This model is not only applicable to microCT but applies to any collaborative scientific endeavor in Africa, with success rates depending on the efficient sharing of resources, providing expert skills and advancing African science in Africa. There is an African proverb “if you want to go fast – go alone; if you want to go far – go together”. Clearly, African science will go far by working together in such facilities.

Prevalence and dynamics of missed opportunities for vaccination among children in Africa: applying systems thinking in a systematic review and meta-analysis of observational studies

ABSTRACTObjective: To estimate the prevalence of missed opportunities for vaccination (MOV) among children aged 0–23 months attending health-care facilities in Africa and explore the factors responsible for MOV using systems thinking.Research design and methods: We conducted a systematic review and meta-analysis of studies reporting the proportion MOVs. Five electronic databases were searched. A random effects model was fitted to obtain pooled estimates of MOV and a causal loop diagram (CLD) was constructed to explore the dynamics of the causes of MOV. MOV was defined as any contact with health services in Africa, by an unvaccinated or under-vaccinated child, aged 0–23 months, who is eligible for vaccination and free of any contraindication, which does not result in vaccination.Results: Four hundred and twenty-one publications were found, of which 20 studies from 14 countries were included. The pooled prevalence of MOV was estimated to be 27.26% (95%CI: 18.80–36.62). A CLD with seven reinforcing and two balancing loops were constructed.Conclusion: Our findings suggest that about one in every four children under the age of two years who visited health facilities in 14 African countries missed the vaccination they were eligible to receive. To enable continent-wide estimates, more MOV assessments are required.

Perspectives on Developing Healthcare Managers in Africa: The Strathmore Business School's Healthcare Management Programme.

A substantial shortage of qualified healthcare professionals in Africa continues, but it is now apparent that professionally trained healthcare managers are an equally important need. Health facilities in Africa typically promote physicians into the role of general manager, but physicians and their lay counterparts routinely admit to being ill-prepared for roles as leaders of health systems, healthcare facilities and other services. Few, if any, degree programmes for healthcare management—be they master's in hospital administration or specialized MBA programmes— are available in these regions. And while many master's in public health programmes exist, inclusion of healthcare management content is often an afterthought. This article presents a prototype programme that was designed to address this gap. This comprehensive healthcare management MBA programme that was established at the Business School of Strathmore University in Nairobi, Kenya in 2013 was built around the “Leadership Competencies for Health Care Managers” as promulgated by the International Hospital Federation. The article further presents the development, structure and innovations of the programme, thus providing a blueprint for the development of similar programmes throughout the continent, aimed at addressing the substantial shortage of professionally trained healthcare managers.

Integrated management of type 2 diabetes and gestational diabetes within multi-morbidity conditions in Africa: a systematic review protocol

IntroductionMulti-morbidity, defined as the co-existence of more than one chronic condition in one person, has been increasing due to comorbid non-communicable and infectious chronic diseases (CNCICDs). Type 2 diabetes (T2D)...

Fourth Industrial Revolution for Development: The Relevance of Cloud Federation in Healthcare Support

Inefficient healthcare is a major concern among many African nations and can be mitigated by building world-class infrastructure connecting different medical facilities for collaboration and resource sharing. Such infrastructure should support collection and exchange of medical data for the purpose of accessing expertise not available locally. It should be equipped with modern technologies of the fourth industrial revolution, providing decision support to doctors thereby enabling African nations leapfrog from poorly equipped to medically prepared. Sadly, world-class healthcare infrastructure are a missing piece in the African public health ecosystem. Medical facilities are either non-existent or prohibitively expensive when they exist. Federated cloud computing can provide a solution to this challenge. Being a model that allows collaboration between multiple Cloud service providers through resources pooling; it allows for the execution of tasks on computing resources flexibly and cost efficiently. This paper aims to connect unconnected medical facilities in Africa by proposing a Cloud federation for healthcare using cooperative and competitive collaboration models. Simulations were carried out to test the efficacy of these models using five different workload allocation schemes: First-Fit-Descending (FFD), Best-Fit-Descending (BFD), Binary-Search-Best-Fit (BSBF); Genetic Algorithm meta-heuristic and Stable Roommate Allocation economic model for both light and heavy workloads. Results of simulations revealed that the cooperative model resulted in lower delays but higher resource utilisation; while the competitive provided faster service delivery and better quality of service. BSBF and BFD resulted in the best resources utilisation and energy conservation. Finally, deployment considerations and potential business models for federated Cloud for African healthcare were presented.

Fly feed firm raises $105 million

AgriProtein Holdings, a U.K.-based start-up, has raised $105 million from undisclosed investors to scale up factories for raising black soldier fly larvae that feed on food waste. The company plans to build facilities in Africa, the Middle East, and Asia that will produce MagMeal, a protein product made from the larvae, to use as feed for fish, poultry, pigs, and pets.

Race, biopolitics and liberal development from the Jim Crow South to postwar Africa

In this paper I document links between the racialised biopolitics that characterised theUSgovernment interventions in theUSSouth in the early 20th century, and theUSA's and theUK's late colonial and early development strategies in Africa. I do so by interrogating why Thomas Campbell, the United States Department of Agriculture's (USDA) head of African‐American agricultural extension, was chosen byUSphilanthropic elites and approved by theUK's Colonial Office to co‐direct a 1944–1945 survey of educational facilities in Africa. I show that it was Campbell's experiences and expertise with “improving” rural life through strategies of self‐help and character‐ and community‐building – key markers of a liberal way of development – that made his presence on the survey seem essential to both theUSAandUKelites. By so doing, this paper documents the importance of theUSDA's biopolitical interventions in theUSSouth for understanding the historical geography of late colonialism and liberal forms of development, thus contributing to critical geographies of development.

Pharmaceutical stockouts: problems and remedies for faith-based health facilities in Africa

Background and aims: Faith-based organizations (FBOs) provide a substantial portion of the health care services in many countries but despite this coverage, many health facilities have struggled to maintain adequate stocks of supplies. The purpose of this study was to identify the types of supply chain systems used by African faith-based health facilities to acquire reproductive health commodities, the performance of the different supply chain system types, their associated challenges and possible corrective actions.Methodology: Through email surveys, phone interviews, and on-site visits, supply chains and challenges of faith-based health facilities in 13 African countries for 16 selected reproductive health (RH) commodities, including contraceptives were studied. Results: Of the 46 facilities surveyed, 55% faced stockouts of one or more products in the three months prior to the survey. Stockouts were less common for contraceptives than other RH products. Significant strengths of the FBO supply chain included creativity in finding other sources of commodities in the face of stockouts, staff designated to monitor quality of the commodities, high capacity for storage, low incidence of expired products, few instances of poor quality, and strong financial sustainability mechanisms, often including patient fees. Weaknesses included unreliable commodity sources and power supplies, long distances to depots, and problems maintaining the cold chain. Five supply chain types were identified. As a result of this study, FBOs in Cameroon have already taken steps to strengthen their supply chain systems and reduce stockouts by forming the Alliance of Christian Faith-Based Organizations for Family Planning (ACFBOFP) in Cameroon. This coalition is raising the profile and fortifying the voice of FBOs toward strengthening FBO commodity security in Cameroon. Conclusions: By studying the supply chains of faith-based health facilities, Christian Connections for International Health (CCIH) and its members have created new awareness among FBOs and international agencies of the importance and challenges of these systems and suggested actions toward improvement. This study can serve as a frame of reference as we move forward, anticipating an acceleration in interest to strengthen FBO supply chains to reach as many communities as possible with supplies and services. The alliance formed in Cameroon to strengthen commodity security may be a good model for other FBOs to consider.

Non-destructive determination of carbohydrate reserves in leaves of ornamental cuttings by near-infrared spectroscopy (NIRS) as a key indicator for quality assessments

The importance of carbohydrate reserves in leaves for rooting performance of ornamental cuttings is well-known. Especially under environmental conditions unfavourable for photosynthesis, sufficient reserves are indispensable for an undisturbed adventitious root formation and to prevent senescence of leaves during rooting. However, due to time and costs, established methods for carbohydrates analysis are not suitable for implementation in global production chains of ornamentals. Near-infrared spectroscopy (NIRS) might be a valuable alternative. To explore the suitability of this technique, NIR spectra were taken from intact cuttings as well as from upper and lower side of detached leaves of chrysanthemum and pelargonium cuttings and partial least squares (PLS) calibration models were developed for glucose, fructose, sucrose and starch in leaves, which were analysed by a stepwise enzymatic-photometric method. Presumably because of a high percentage of cuttings with very low amounts of glucose, fructose and sucrose, calibration models for single soluble sugars and sum of soluble sugars were poor (RCV2 ≤ 0.5, RPDCV ≤ 1.5), while prediction performance for starch and sum of starch and soluble sugars was quite good (R2 > 0.8, RPD > 2.0, RER > 10). The high number of cuttings with depleted reserves of soluble sugars seems to have been at least partly caused by transportation of cuttings, before NIR analysis, from stock plant facilities in Africa and Latin America to Central Europe. The quite low levels of leaf carbohydrates on delivery at rooting facilities cannot be detected by NIRS properly. Thus, NIRS seems to be more suitable for monitoring of leaf carbohydrates in stock plants to optimise crop management than for assessment of cutting quality before rooting.

Socio-economic Determinants of Women Access to Healthcare Services in Sub-Saharan Africa

The study examined the socio-economic determinants of women access to healthcare services in Sub-Saharan Africa for the period 1995-2015. The study adopted the dynamic panel model and estimated it using the System Generalized Method of Moments in a bid to overcome the endogeneity problem inherent in the model of study. The study harmonized the theoretical strands in literature by describing the measure of access determinants as three main components: i. health service availability, ii. Health service utilization and, iii. Health service decision. The indicators of health service availability such as community health workers, physician, nurses and midwives and hospital beds improve women access to healthcare facilities in Africa. Also, health service utilization indicators such as population density worsen the quality of healthcare services available to women while electricity access and private health expenditure enhances women access to quality healthcare delivery. Health service decision indicators such as female bank account ownership, female labour force participation, attainment of basic education and female household headship were important in enhancing women access to healthcare facilities. Generally, women health outcomes were more responsive to health service utilization; implying that service utilization is an important proof of healthcare access in Africa.

THE QUEST FOR BUILDING LABORATORY CAPACITY TO SUPPORT CONTROLLED HUMAN MALARIA INFECTION (CHMI) STUDIES IN SUB-SAHARAN AFRICA: EXPERIENCE WITH FIVE SITES

BackgroundConducting Controlled Human Malaria Infection (CHMI) studies in sub-Saharan Africa presents unique challenges yet it provides enormous opportunities for fast-tracking malaria vaccine and drug development. Sanaria Inc. USA, has devised...

ANTIBIOTIC RESISTANCE PATTERNS OF POTENTIAL PATHOGENS ISOLATED FROM TWO MAJOR HOSPITALS IN LUSAKA AND NDOLA

BackgroundThis study was conducted as part of an assessment of the effectiveness of existing hygiene and sanitation practices in two first-level hospitals in Lusaka and two central clinics in Ndola...

High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study.

SUMMARYBACKGROUND: Adults with suspected tuberculosis (TB) in health facilities in Africa have a high risk of death. The risk of death for adults with suspected TB at community-level is not known but may also be high.METHODS: Adults reporting cough of ⩾ 2 weeks (coughers) during a household census of 19 936 adults in a poor urban setting in Malawi were randomly sampled and age-frequency matched with adults without cough ⩾ 2 weeks (controls). At 12 months, participants were traced to establish vital status, offered human immunodeficiency virus (HIV) testing and investigated for TB if symptomatic (sputum for Xpert® MTB/RIF, smear microscopy and culture).RESULTS: Of 345 individuals with cough, 245 (71%) were traced, as were 243/345 (70.4%) controls. TB was diagnosed in 8.9% (16/178) of the coughers and 3.7% (7/187) of the controls (P = 0.039). HIV prevalence among coughers was 34.6% (56/162) and 18.8% (32/170) in controls (P = 0.005); of those who were HIV-positive, respectively 26.8% and 18.8% were newly diagnosed. The 12-month risk of death was 4.1% (10/245) in coughers and 2.5% (6/243) in controls (P = 0.317).CONCLUSION: Undiagnosed HIV and TB are common among adults with chronic cough, and mortality is high in this urban setting. Interventions that promote timely seeking of HIV and TB care are needed.

Can innovative ambulance transport avert pregnancy-related deaths? One-year operational assessment in Ethiopia.

BackgroundTo maximise the potential benefits of maternity care services, pregnant women need to be able to physically get to health facilities in a timely manner. In most of sub–Saharan Africa, transport represents a major practical barrier. Here we evaluate the extent to which an innovative national ambulance service in Ethiopia, together with mobile phones, may have been successful in averting pregnancy–related deaths.MethodsAn operational assessment of pregnancy–related deaths in relation to utilisation of the new national ambulance service was undertaken in six randomly selected Districts in northern Ethiopia. All 183 286 households in the six randomly selected Districts were visited to identify live–births and deaths among women of reproductive age that occurred over a one–year period. The uptake of the new ambulance transport service for women’s deliveries in the same six randomly selected Districts over the same period was determined retrospectively from ambulance log books. Pregnancy–related deaths as determined by the World Health Organization (WHO 2012) verbal autopsy tool [13] and the InterVA–4 model [14] were analysed against ambulance utilisation by District, month, local area, distance from health facility and mobile network coverage.FindingsA total of 51 pregnancy–related deaths and 19 179 live–births were documented. Pregnancy–related mortality for Districts with above average ambulance utilisation was 149 per 100 000 live–births (95% confidence interval CI 77–260), compared with 350 per 100 000 (95% CI 249–479) for below average utilisation (P = 0.01). Distance to a health facility, mobile network availability and ambulance utilisation were all significantly associated with pregnancy–related mortality on a bivariable basis. On a multivariable basis, ambulance non–utilisation uniquely persisted as a significant determinant of mortality (mortality rate ratio 1.97, 95% CI 1.05–3.69; P = 0.03).ConclusionsThe uptake of freely available transport in connection with women’s obstetric needs correlated with substantially reduced pregnancy–related mortality in this operational assessment, though the design did not allow cause and effect to be attributed. However, the halving of pregnancy–related mortality associated with ambulance uptake in the sampled Districts suggests that the provision of transport to delivery facilities in Africa may be a key innovation for delivering maternal health care, which requires wider consideration.

The relative patient costs and availability of dental services, materials and equipment in public oral care facilities in Tanzania.

BackgroundPatient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied.MethodsA survey of all district and regional dental clinics in selected regions was conducted in 2014. A total of 28/30 facilities participated in the study. A structured interview was undertaken amongst practitioners and clinic managers within the facilities. Daily resources for consumption (DRC) were used for estimation of patients’ relative cost. DRC are the quantified average financial resources required for an adult Tanzanian’s overall consumption per day.ResultsTooth extractions were found to cost four times the DRC whereas restorations were 9–10 times the DRC. Studied facilities provided tooth extractions (100 %), scaling (86 %), fillings (79 %), root canal treatment (46 %) and fabrication of removable partial dentures (32 %). The ratio of tooth fillings to extractions in the facilities was 1:16. Less than 50 % of the facilities had any of the investigated dental materials consistently available throughout the year, and just three facilities had all the investigated equipment functional and in use.ConclusionsDental materials and equipment availability, skills of the practitioners and the cost of services all play major roles in provision and utilization of comprehensive oral care. These factors are likely to be interlinked and should be taken into consideration when studying any of the factors individually.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0061-3) contains supplementary material, which is available to authorized users.