Health Care System In Africa Research Articles

A scoping review of Enhanced Recovery After Surgery (ERAS), protocol implementation, and its impact on surgical outcomes and healthcare systems in Africa

BackgroundEnhanced Recovery After Surgery (ERAS) is a patient-centered approach to surgery designed to reduce stress responses and facilitate faster recovery. ERAS protocols have been widely adopted in high-income countries, supported by robust research demonstrating improved patient outcomes. However, in Africa, there is limited evidence regarding its implementation. This review aims to identify the existing literature on the implementation of ERAS principles in Africa, the reported clinical outcomes, and the challenges and recommendations for successful implementation.MethodsWe conducted a librarian-assisted literature search of electronic research databases between October and November 2023. Titles and abstracts were screened for eligibility, and duplicates were then removed, followed by full-text assessment of potentially eligible studies. We utilized the summative content analysis method to synthesize and group the data into fewer categories based on agreed-upon criteria. Descriptive statistics were used to describe the results.ResultsThe search identified 342 potential studies resulting in 15 eligible studies for inclusion in the review. The publication years ranged from 2016 to 2023. The studies originated from three countries: Egypt (n = 10), South Africa (n = 4), and Uganda (n = 1). Successful implementation was associated with reduced hospital length of stay (n = 12), lower mortality rates (n = 3), and improved pain outcomes (n = 7). Challenges included protocol adherence (n = 5) and limitations of the research design to generate strong evidence (n = 3). Recommendations included formal adoption of ERAS principles (n = 5), the need for sustained research commitment, and exploration of the applicability of ERAS in diverse surgical contexts (n = 8). Large-scale implementation beyond individual institutions was encouraged to further validate its impact on patient outcomes and healthcare costs (n = 1).ConclusionsDespite the limited number of studies on ERAS implementation in Africa, the available evidence suggests that it reduces the length of hospital stays and mortality rates. This is crucial for the region, given its higher mortality rates, necessitating more collaborative, methodically well-designed studies to establish stronger evidence for ERAS in lower-resource environments.

A scoping review of the management of prostate cancer in Africa

Prostate cancer is one of the most frequently diagnosed cancers in menand a major cause of cancer-related deaths in men, globally. The managementof prostate cancer in Africa is unique; most patients present withadvanced disease as result of a largely under-developed healthcare delivery.However, due to the underdeveloped healthcare system in Africa,there are unique limitations to delivering these treatments. Thus, the needfor this scoping review on the management of prostate cancer in Africa.Aim: To give an account of the pattern of presentation, histological types,investigative and treatment modalities of prostate cancer in Africa. A literaturesearch through PubMed, Google Scholar, and African Journal Onlineon the management of prostate cancer in Africa was conducted. Results arethen reported according to the Preferred Reporting Items for SystematicReview and Meta-analyses extension for Scoping Review. Forty-three articlesfully satisfied the inclusion criteria and were used for this review.The commonest presentation of prostate cancer was lower urinarytract symptoms, followed by bone pain and urinary retention in that order.Adenocarcinoma was the commonest histological type for 98.5% of thestudy. A total 23.3% of patients had hormonal treatment which was the commonesttreatment option. Chemotherapy and open radical prostatectomywere used in 17.7 and 12.9% cases respectively. The use of robot-assistedradical prostatectomy was not an option of care noted in the review. Thefindings of this study highlight the need for integration of modern investigativemodalities and treatment options for prostate cancer in Africa.

The role of clinical associates in South Africa as a health workforce: A scoping review.

South Africa's health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers. This study mapped Clin-As' history and practice in South Africa, assessing their roles in the health workforce and offering recommendations. Following the framework outlined by Arksey and O'Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening. Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As' perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation. As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa's health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition.Contribution:This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.

Unveiling the Dual Threat: How Microbial Infections and Healthcare Deficiencies Fuel Cervical and Prostate Cancer Deaths in Africa.

Cervical and prostate cancer account for 7.1 and 7.3 deaths per 100,000 people globally in 2022. These rates increased significantly to 17.6 and 17.3 in Africa, respectively, making them the second and third leading cause of cancer deaths in Africa, only surpassed by breast cancer. The human papillomavirus is the prime risk factor for cervical cancer infection. On the other hand, prostate cancer risks include ageing, genetics, race, geography, and family history. However, these factors alone cannot account for the high mortality rate in Africa, which is more than twice the global mortality rate for the two cancers. We searched PubMed, Embase, Scopus, and Web of Science to select relevant articles using keywords related to microorganisms involved in cervical and prostate cancer and the impact of poor healthcare systems on the mortality rates of these two cancers in Africa by carrying out a detailed synopsis of the studies on microbial agents involved and the contributory factors to the deteriorating healthcare system in Africa. It became apparent that the developed countries come first in terms of the prevalence of cervical and prostate cancer. However, more people per capita in Africa die from these cancers as compared to other continents. Also, microbial infections (bacterial or viral), especially sexually transmitted infections, cause inflammation, which triggers the pathogenesis and progression of these cancers among the African population; this has been linked to the region's deficient health infrastructure, making it difficult for people with microbial infections to access healthcare and hence making infection control and prevention challenging. Taken together, untreated microbial infections, primarily sexually transmitted infections due to the deficient healthcare systems in Africa, are responsible for the high mortality rate of cervical and prostate cancer.

Exploring strategies for building a sustainable healthcare system in Africa: lessons from Japan and Switzerland.

Strengthening healthcare infrastructure is an important strategy for building a sustainable healthcare system in Africa. This involves investing in facilities, equipment, and supplies, as well as training and retaining skilled healthcare workers. Additionally, improving healthcare infrastructure and investing in healthcare education and training can lead to significant improvements in health outcomes, such as reducing maternal and child mortality. This is critical for building a sustainable healthcare system. Through a literature review, we assessed the approaches to building a sustainable healthcare system in Africa from the perspectives of Japan's and Switzerland's healthcare systems. It was discovered that Japan currently has the highest life expectancy, which can be attributed to insurance policies, healthcare policies, and the integration of emerging technologies and clinical research into their healthcare system. Lessons that Africa must emulate from the Japanese healthcare system include ensuring universal healthcare coverage, improving the workforce, improving primary healthcare, prioritizing the aging population, and investing in technology, infrastructure, and research. Japans healthcare system is also sustainable thanks to its stable workforce and primary healthcare. Switzerland also has an exceptional healthcare system globally, with technical and socioeconomic advancements leading to increased life expectancy and population aging through a worldwide health policy approach, programs tackling professional responsibilities and interprofessional cooperation, and initiatives to support family medicine. By learning from Japan's and Switzerland's approaches, Africa will gradually achieve the Sustainable Development Goals and build a sustainable healthcare system.

Interest Groups and COVID-19 in Africa(2019-2022).

The study highlights the crucial roles played by interest groups in shaping the definition and redefinition of policy issues related to the COVID-19 pandemic in Africa. The study focused on selected countries to discuss strategies that were deployed to combat the COVID quandary. The selected countries are Nigeria, Ghana, Kenya, Tanzania, South Africa, Zimbabwe, Egypt, and Tunisia. A purely qualitative research, it relied on existing literature sources to produce thematic analysis which explore the various strategies adopted by interest groups in addressing the COVID-19 pandemic in Africa. The study revealed the challenges posed by the COVID-19 pandemic to the already fragile healthcare system in Africa. Again, it revealed the innovative approaches such as herbal medicine and local production of ventilators developed by African countries to tackle COVID-19 including efforts of other interests groups like government agencies, private institutions and international organizations in the fight against COVID-19 in Africa.

Addressing hydrocephalus in Africa: Challenges and way forward.

Hydrocephalus occurs when the cerebrospinal fluid (CSF) accumulates in the cerebral ventricles. This is due to either obstruction in the CSF flow, decreasing its absorption by the arachnoid villus to the Dural venous sinuses, or increasing production of the CSF. The most disproportionately and severely affected by the disease consequences are African children. This is because of the high incidence of postinfectious hydrocephalus and spinal dysraphism compared with other world children. The health care system in Africa has access to 488 neurosurgeons which represents less than 1% of the global neurosurgeons, thus pediatric hydrocephalus is considered an emerging public health problem in Africa because of the difficulty of the patient's access to proper care. Numerous studies conducted in Africa have revealed a significant imbalance in the distribution of neurosurgical resources across the continent. Specifically, South Africa and North Africa collectively account for 86% of the total practicing neurosurgeons, indicating a pronounced concentration of these specialized medical professionals in these regions. Having an abundance of case studies regarding hydrocephalus is vital to increase our awareness and understanding. Hydrocephalus should gain more priority by current policymakers as an important health concern. This may be achieved by proper resource allocation to ensure better quality means of diagnosis, intervention, and rehabilitation.

Development of a «people-centred approach» to realising healthcare by facilitating, patient participation in health attainment in South Africa and Ukraine

Object of this research is South Africa's healthcare system. South Africa's healthcare system faces numerous challenges that contribute to inadequate access to quality healthcare for its citizens. These challenges include a scarcity of healthcare workers, insufficient funding and resource allocation, a high burden of communicable and non-communicable diseases, as well as disparities in healthcare access and outcomes driven by socioeconomic status and geographic location. Consequently, many South Africans endure unfavourable health outcomes, limited availability of essential health services, and a prevailing sense of mistrust towards the healthcare system. Concurrently, Ukraine has encountered its own set of healthcare obstacles, including similar shortages of healthcare professionals, funding deficiencies, and disparities in healthcare access exacerbated by armed conflict. This study provides insights into the patient experience, utilizing Kolb's experiential learning theory. It employs qualitative and quantitative methods, including a questionnaire administered to conveniently sampled participants at Chris Hani Baragwanath hospital's HIV/AIDS unit. Data analysis using Excel and SPSS reveals a communication gap between healthcare workers and patients, highlighting the need for Department of Health training on communication and diversity. Finally, the implementation of consistent patient feedback mechanisms is essential for healthcare institutions to comprehend evolving patient needs, fostering the adoption of a «people-centred» approach to delivering high-quality healthcare services. By incorporating insights from Ukraine's challenges, this study not only addresses the specific healthcare obstacles faced by South Africa but also provides a broader perspective on healthcare issues across diverse contexts. These insights enable policymakers and healthcare professionals to identify potential solutions and work towards improving healthcare access and outcomes for all citizens, ensuring the overall health and well-being of the population of South Africa and other countries with similar challenges.

Update on the Phylodynamic and Genetic Variability of Marburg Virus.

The COVID-19 pandemic has not only strained healthcare systems in Africa but has also intensified the impact of emerging and re-emerging diseases. Specifically in Equatorial Guinea, mirroring the situation in other African countries, unique zoonotic outbreaks have occurred during this challenging period. One notable resurgence is Marburg virus disease (MVD), which has further burdened the already fragile healthcare system. The re-emergence of the Marburg virus amid the COVID-19 pandemic is believed to stem from a probable zoonotic spill-over, although the precise transmission routes remain uncertain. Given the gravity of the situation, addressing the existing challenges is paramount. Though the genome sequences from the current outbreak were not available for this study, we analyzed all the available whole genome sequences of this re-emerging pathogen to advocate for a shift towards active surveillance. This is essential to ensure the successful containment of any potential Marburg virus outbreak in Equatorial Guinea and the wider African context. This study, which presents an update on the phylodynamics and the genetic variability of MARV, further confirmed the existence of at least two distinct patterns of viral spread. One pattern demonstrates a slower but continuous and recurring virus circulation, while the other exhibits a faster yet limited and episodic spread. These results highlight the critical need to strengthen genomic surveillance in the region to effectively curb the pathogen's dissemination. Moreover, the study emphasizes the importance of prompt alert management, comprehensive case investigation and analysis, contact tracing, and active case searching. These steps are vital to support the healthcare system's response to this emerging health crisis. By implementing these strategies, we can better arm ourselves against the challenges posed by the resurgence of the Marburg virus and other infectious diseases.

Chinese health funding in Africa: The untold story.

The motivations behind China's allocation of health aid to Africa remain complex due to limited information on the details of health aid project activities. Insufficient knowledge about the purpose of China's health aid hinders our understanding of China's comprehensive role in supporting Africa's healthcare system. To address this gap, our study aimed to gain better insights into China's health aid priorities and the factors driving these priorities across Africa. To achieve this, we utilized AidData's Chinese Official Finance Dataset and adhered to the Organisation for Economic Co-operation and Development (OECD) guidelines. We reclassified all 1,026 health projects in Africa, originally categorized under broad 3-digit OECD-DAC sector codes, into more specific 5-digit CRS codes. By analyzing the project count and financial value, we assessed the shifting priorities over time. Our analysis revealed that China's priorities in health aid have evolved between 2000 and 2017. In the early 2000s, China primarily allocated aid to basic health personnel and lacked diversity in sub-sectors. However, after 2004, China shifted its focus more toward basic infrastructure and reduced emphasis on clinical-level staff. Furthermore, China's interest in addressing malaria expanded both in scale and depth between 2006 and 2009. This trend continued in 2012 and 2014 when China responded to the Ebola outbreak by shifting its focus from basic infrastructure to infectious diseases. In summary, our findings demonstrate the changes in China's health aid strategy, starting with addressing diseases already eliminated in China and gradually transitioning towards global health security, health system strengthening, and shaping the governance mechanisms.

LEVERAGING TELE-EDUCATION AS AN EFFECTIVE PLATFORM TO PROVIDE EASY ACCESS TO HEALTHCARE WORKERS ON HYPERTENSION MANAGEMENT IN SUB-SAHARAN AFRICA

Objective: This study aims at showing the efficacy of using tele-education in making knowledge easily accessible to healthcare workers by using the University of New Mexico's Project ECHO® model. This model provides healthcare workers access to evidence-based knowledge to combat the challenges associated with sub-optimal training and depleting resources across Sub-Saharan Africa's healthcare system. This effort has led to significant improvement in the quality of healthcare service delivery. Design and method: Aggregate data were obtained from 4 Tele-education sessions conducted between August 2022- November 2022 to improve the capacity of Healthcare workers. Each session included a didactic presentation by a subject matter expert and a case study presentation by a healthcare worker. The case presentation involved citing real-life hypertension-related cases at the health facility to enable peer-to-peer learning exchange, as encouraged by the ECHO® model for Healthcare workers. The impacts of the sessions were measured using the pre and post-session tests to evaluate the knowledge gained by participants. Results: The population of this study was the 1,389 Healthcare workers from different cadres (such as doctors, nurses, midwives, lab scientists, Community Health Extension Workers (CHEWs), and mid-level managers) who joined the tele-education sessions. There was an average knowledge gain of 11.1%. Over 1.7 million indirect beneficiaries (patients) were reached through services provided by these trained Healthcare workers. Conclusions: The knowledge gained demonstrated the effectiveness of tele-education in improving the capacity of Healthcare workers to provide quality services in managing patients living with or at risk of hypertension. Tele-education cuts across most of the barriers encountered in spreading knowledge to healthcare workers and promotes health literacy and improved service delivery.

Digital health systems strengthening in Africa for rapid response to COVID-19.

The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening efforts, which requires coordinated interventions to increase access, efficiency, quality, transparency, equity, and flexibility of health services. We postulate that rapid digitalization of health interventions is a key way forward to increase resilience of African health systems to epidemic challenges. In this paper we describe how PharmAccess' ongoing digital health system interventions in Africa were rapidly customized to respond to COVID-19. We describe how we developed: a COVID-19 App for healthcare providers used by more than 1,000 healthcare facilities in 15 African countries from May-November 2020; digital loans to support private healthcare providers with USD 20 million disbursed to healthcare facilities impacted by COVID-19 in Kenya; a customized Dutch mobile COVID-19 triage App with 4,500 users in Ghana; digital diaries to track COVID-19 impacts on household expenditures and healthcare utilization; a public-private partnership for real-time assessment of COVID-19 diagnostics in West-Kenya; and an expanded mobile phone-based maternal and child-care bundle to include COVID-19 adapted services. We also discuss the challenges we faced, the lessons learned, the impact of these interventions on the local healthcare system, and the implications of our findings for policy-making. Digital interventions bring efficiency due to their flexibility and timeliness, allowing co-creation, targeting, and rapid policy decisions through bottom-up approaches. COVID-19 digital innovations allowed for cross-pollinating the interests of patients, providers, payers, and policy-makers in challenging times, showing how such approaches can pave the way to universal health coverage and resilient healthcare systems in Africa.

Delivering a Drug Information App to Underserved Communities: A User-Centered Design Approach

ABSTRACT Two-thirds of the Sub-Saharan African population is rural and faces significant challenges accessing healthcare facilities and information. The mobile phone offers feasible opportunities to improve healthcare access to underserved communities. The study aims to develop an app for communities with limited access to health information. Design Science Research Methodology (DSRM) was adopted. A three-cycle DSRM guided the development of a mHealth app using a user-centered design process involving potential users, from conceptualizing the idea to prototype evaluation. The methodology allows the researcher to empathize with the participants, consider their contextual and environmental circumstances and understand their needs better. The prototype provides access to information about known drugs, their known uses, side effects, organs affected, or the human system they affect. A total of 206 participants evaluated the app for its usefulness, efficiency, error handling, memorability, learnability, and design. Participants concluded that the app was usable, easy to learn, error-free, and useful through a mean score of 3.95 and Cronbach’s alpha coefficient range of 0.75 to 0.85. Policymakers and researchers may find the results helpful in improving mHealth adoption. Integrating the app with the broader e-health systems will offer more convenience and efficiency, as healthcare systems in Africa are largely manual.

Prevalence, determinants and attitude towards herbal medicine use in the first trimester of pregnancy in Cameroon: A survey in 20 hospitals.

To examine the prevalence, determinants and attitude towards herbal medication (HM) use in the first trimester of pregnancy in Cameroon women. Between March to August 2015, we surveyed 795 pregnant women attending 20 randomly selected urban or rural hospitals in South West Cameroon on first trimester orthodox medication (OM) and HM use. Data was obtained by interviews using structured questionnaires. First trimester HM use was reported by 293 (36∙9%) women, 76% of whom used it in combination with OM. The most frequent indication for taking HM was prevention/treatment of anaemia (26∙3%). The HM were usually self-prescribed (33∙3%) or by family (56∙2%), and obtained from the woman's own garden (69∙3%). Twenty percent of women believed that HM was always safe to take in pregnancy, compared to 69.3% for OM. Intake of HM was significantly influenced by women's opinion on OM or HM safety-the odds of taking HM was 3 time higher among women who were unsure about the safety of OM (AOR: 3∙0, 95%CI = 1∙5-6∙1), while women who thought HM were never safe or who were unsure about its safety, were 91% or 84% respectively less likely to take HM compared to women who believed HM were always safe. We identified a high prevalence of HM use and concomitant use with OM, strongly influenced by women's perception of HM and OM safety. These findings indicate the need for WHO to specifically address safety in pregnancy in its policy to integrate traditional medicine use into existing healthcare systems in Africa.

Educational intervention to enhance the knowledge of Ghanaian health workers on Alzheimer’s disease and related dementias

BackgroundAlzheimer’s disease and related dementias (ADRDs) pose a major public health challenge in older adults. In sub-Saharan Africa, the burden of ADRD is projected to escalate amidst ill-equipped healthcare workers (HCWs).AimThis study aimed to assess ADRD knowledge amongst Ghanaian HCWs and improve gaps identified through a workshop.SettingStudy was conducted among HCWs attending a workshop in Kumasi, Ghana.MethodsOn 18 August 2021, a workshop on ADRD was organised in Kumasi, Ghana, which was attended by 49 HCWs comprising doctors, nurses, pharmacists, social workers and nutritionists. On arrival, they answered 30 pre-test questions using the Alzheimer’s Disease Knowledge Scale (ADKS). A post-test using the same questionnaire was conducted after participants had been exposed to a 4-h in-person educational content on ADRD delivered by facilitators from family medicine, neurology, geriatrics, psychiatry and public health.ResultsThe mean age of participants was 34.6 (± 6.82), mean years of practice was 7.7 (± 5.6) and 38.8% (n = 19) were nurses. The mean score of participants’ overall knowledge was 19.8 (± 4.3) at pre-test and 23.2 (± 4.0) at post-test. Participants’ pre-test and post-test scores improved in all ADKS domains. Factors associated with participants’ knowledge at baseline were profession, professional rank and the highest level of education attained. After adjusting for age and sex, participant’s rank, being a specialist (adjusted β = 14.44; 95% confidence interval [CI] = 7.03, 21.85; p < 0.001) was an independent predictor of knowledge on Alzheimer’s disease.ConclusionExisting knowledge gaps in ADRD could be improved via continuous medical education interventions of HCWs to prepare healthcare systems in Africa for the predicted ADRD epidemic.

Rift Valley fever during the COVID-19 pandemic in Africa: A double burden for Africa's healthcare system.

A new rising incidence of Rift Valley fever (RVF) among livestock and humans in the African continent during the COVID‐19 pandemic has become of increasing concern. We analyzed the different ways COVID‐19 has contributed to the increase in RVF cases and how it has impacted the interventions allocated to the disease by comparing it with the status of the disease before the pandemic. There is enough evidence to conclude that the COVID‐19 pandemic has impacted the efforts being taken to prevent outbreaks of RVF. Therefore, with no definitive treatment in place and inadequate preventive measures and disease control, RVF may potentially lead to a future epidemic unless addressed urgently.

The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response

BackgroundThe COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how...

The 'sleeping elephant': The role of mentorship of critical care nurses in Zambia.

To develop and evaluate a Zambian context-specific mentorship model that supports registered nurses completing emergency, trauma and critical care programmes in Zambia. In Zambia, emergency and trauma and critical care nursing are relatively new specialties, with education and training programmes less than a decade old. A train the trainer mentorship programme was developed and delivered at two colleges of nursing. Ethics approval was gained in both Zambia and the UK. Documentary data analysis and focus groups were used. Focus groups included stakeholders and nurses in practice who had completed the train the trainer programme and were using the mentorship model. The critical review of the literature revealed there was a paucity of evidence on the role of mentors in critical care. However, national documentation identified that most post basic education programmes are at Diploma Level with limited content that focuses on bedside teaching, mentorship and assessment content. Feedback from representatives attending the stakeholder workshops and focus groups which included participants who had completed the training programme enabled the mentorship model and workshop to be developed and evaluated. Nurses are the backbone of healthcare systems in Africa and the world. Mentorship and assessment in practice enables nurses to develop the competence and skills to lead practice, support peers and junior colleagues. This paper has identified the need for a context-specific formalised mentorship model to support specialist practice and this project has provided the foundations for mentorship of emergency, trauma and critical care nurses in Zambia.

Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment

Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals. Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance. Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%). Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.

Nurturing next-generation biomedical engineers in Africa: The impact of Innovators’ Summer Schools

The mission of healthcare systems in Africa to deliver compassionate and effective care has been constrained by growing populations, increasing burden of disease, political conflict and limited resources. The impacts of these constraints can be substantially alleviated, and the healthcare services strengthened, through the creation and adoption of affordable, accessible and appropriate biomedical engineering systems and technologies. There is an urgent need for building capacities in biomedical engineering, innovation and entrepreneurship in African countries. The African Biomedical Engineering Consortium has been organising a series of Innovators’ Summer Schools to meet this need by empowering students and researchers with entrepreneurial and innovative skills, and facilitating the design and development of robust, appropriate, and commercially viable medical systems and devices. In this paper, we analyse and discuss the impact of six of these schools held between 2012 and 2017. We used a questionnaire-based survey to collect responses from students who had attended the summer schools. The results of this study demonstrate that the teaching-learning model adopted in the ABEC summer schools was largely effective in promoting biomedical engineering skills, career choices, professional networks and partnerships amongst young African engineers and life scientists who attended the summer schools.