Hospital In sub-Saharan Africa Research Articles

"EM Doc On Call:" A Pilot Study to Improve Interhospital Transfers in Rwanda.

Treatment of seriously ill patients is often complicated by prolonged or complex transfers between hospitals in sub-Saharan Africa. Difficulties or inefficiency in these transfers can lead to poor outcomes for patients. "On-call" triage systems have been utilized to facilitate communication between facilities and to avoid poor outcomes associated with patient transfer. This study attempts to examine the effects of a pilot study to implement such a system in Rwanda. Data collection occurred prospectively in two stages, pre-intervention and intervention, in the emergency department (ED) at Kigali University Teaching Hospital (CHUK). All patients transferred during the pre-determined timeframe were enrolled. Data were collected by ED research staff via a standardized form. Statistical analysis was performed using STATA version 15.0. Differences in characteristics were assessed using χ2 or Fisher's exact tests for categorical variables and independent sample t-tests for normally distributed continuous variables. During the "on call" physician intervention, the indication for transfer was significantly more likely to be for critical care (P <.001), transfer times were faster (P <.001), patients were more likely to be displaying emergency signs (P <.001), and vital signs were more likely to be collected prior to transport (P <.001) when compared to the pre-interventional phase. The "[Emergency Medicine] EM Doc On Call" intervention was associated with improved timely interhospital transfer and clinical documentation in Rwanda. While these data are not definitive due to multiple limitations, it is extremely promising and worthy of further study.

Blood transfusion for children in sub-Saharan Africa: 200 years on

In 1818, James Blundell completed the first successful human blood transfusion. This life-saving medical intervention has revolutionised patient care globally in the past two centuries. Nevertheless, many challenges remain in implementing safe blood transfusion procedures, particularly in sub-Saharan Africa 1 Ala F Allain JP Bates I et al. External financial aid to blood transfusion services in sub-Saharan Africa: a need for reflection. PLoS Med. 2012; 9e1001309 Crossref PubMed Scopus (53) Google Scholar where demand predominantly centres on acute paediatric severe anaemia and haemorrhagic complications of pregnancy and trauma. Severe anaemia, when the haemoglobin concentration drops below 6 g/dL, is very common in children admitted to hospital in sub-Saharan Africa. Infectious diseases, nutritional deficiencies, and sickle cell anaemia are the major underlying causes of anaemia. Outcomes remain unsatisfactory, with high mortality and high hospital readmission rates within 6 months of initial admission. 2 Phiri KS Calis JC Faragher B et al. Long term outcome of severe anaemia in Malawian children. PLoS One. 2008; 3e2903 Crossref PubMed Scopus (75) Google Scholar World Blood Donor Day on June 14, 2023, calls for donors to “Give blood, give plasma, share life, share often”. Not only is this a day to celebrate the charitable contributions of blood donors, it is an important opportunity to raise awareness that every pint of blood donated results in critically important life-sustaining therapy, especially for children in sub-Saharan Africa.

Discharge against medical advice: cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa.

Discharge against medical advice (DAMA) is a worldwide phenomenon. It continues to challenge the healthcare system and has profound effects on outcomes of treatment. It is when a patient leaves the hospital against the treating physician's recommendation. The objectives of this study are to identify the prevalence, associated factors, and proffer recommendations to mitigate the anomaly in our local/regional healthcare system. This was a cross-sectional study with data collected from consecutive patients who sought DAMA at the accident and emergency department of the hospital from October 2020 to March 2022. Data were analyzed using SPSS version 26. Descriptive and inferential statistics were used for data presentation. Ninety-nine cases of DAMA out of 4608 patients seen at the Emergency Department during the study period, giving a prevalence rate of 2.14%. 70.7% (70) of these patients were aged 16-44years with male-to-female ratio of 2.5:1. An estimated half the number of the patients who DAMA were traders 44.4% (44), 14.1% (14) were in paid employment, 22.2% (22) were unskilled workers, and 3% (3) unemployed. Financial constraint was the leading cause in 73 (73.7%) cases. The majority of patients had limited or no formal education, and this was significantly associated with DAMA (P = 0.032). Ninety-two patients (92.6%) sought discharge within 72h of admission and 89 (89.9%) admitted to leaving to seek alternative methods of care. DAMA is still a problem in our environment. Comprehensive health insurance must be mandatory for all citizens with improved scope and coverage, especially for trauma victims.

The Indoor Climate of Hospitals in Tropical Countries: A Systematic Review

An indoor climate impacts human comfort, well-being, and safety. Therefore, it remains an important topic since, nowadays, people spend a significant amount of time indoors. Additionally, as tropical geographical zones become more populated, urbanised, and industrialised, the energy demand for air conditioning will rise significantly. In terms of the indoor climate, hospitals are particularly demanding due to the special needs of their occupants, however there is a paucity of studies about the tropics. Through a systematic analysis of accessible data and peer-reviewed articles, this study performed a quantitative and qualitative review of the scientific studies selected by the defined inclusion and exclusion parameters. A total of 65 tropics-related scientific publications, 28 on indoor thermal comfort and 37 on indoor air quality published between 2000 and 2023, were systematically reviewed. This study’s findings corroborated those from the previous studies, alluding that there is a paucity of scientific studies on the indoor climate conditions of buildings in tropical countries. A total of 42 studies (65%) were conducted in Asia and 15 studies (23%) in Africa. Six studies (9%) were reported in South America and two studies (3%) were obtained from Oceania, Australia. The results indicated that tropical Africa recorded the lowest number of indoor climate studies considering the population indices. Many of the reviewed indoor climate studies employed mixed methods, whereas only very few considered a seasonal approach. Meanwhile, in the developing tropics, only one record was found regarding an indoor climate study of hospitals based on their locations (correlating the outdoor and indoor air quality). Additionally, no record was found regarding the IC studies of hospitals in sub-Saharan Africa, in which, the IC impact on the occupant’s performance, productivity, and behaviour was assessed. Inferably, gaps still exist in the indoor climate of tropical hospitals. The current study highlights the need to improve the indoor climate considerations in the design, siting, awareness, regulations, and policy implementations concerning the hospitals in developing tropical countries. In conclusion, the study emphasises the need for more scientific studies on the indoor climate of tropical hospitals and highlights the relevant areas of the indoor climate studies in future works for considering the climate, environmental, socio-economic, infrastructural, and demographic peculiarities of the tropics for the betterment of hospital indoor climates in developing tropical countries.

Epidemiology Trend of Chronic Kidney Disease in a Semi-Urban Tertiary Hospital in Sub-Saharan Africa.

Background The global burden of chronic kidney disease (CKD) has been on an alarming increase in the last two decades. The morbidity and mortality associated with CKD are even worse in Nigeria, like other developing countries, due to multiple socioeconomic and demographic factors in the country. CKD contributes to the increasing need for hospital admission. Hypertension and chronic glomerulonephritis have been the leading causes of CKD in Nigeria. However, diabetic nephropathy has recently gained more significance as a cause of CKD in developing countries. Aim and methods This study aimed to describe the current trend in the burden and population characteristics of CKD in Southern Nigeria. This is a cross-sectional, hospital-based study. The study recruited adult patients with prehemodialysis CKD seen in renal clinics over a two-year period (November 2014 to October 2016). Data were obtained using a questionnaire and from the clinic register. All participants were clinically assessed, including history, anthropometric measurements, and urinary albumin-creatinine ratio. Results A total of 1,549 patients were seen at the Medical Outpatient Clinic over the study period. CKD accounted for 9.7% of medical outpatient clinic attendance. The mean age of participants was 49±13 years. The leading causes of CKD were diabetes mellitus (32%), chronic glomerulonephritis (30%), and hypertension (22%). Among the participants, CKD stages 3, 4, and 5 were prevalent in 26.7%, 43.3%, and 14.7%, respectively. Conclusion and recommendation CKD is very prevalent among medical clinic patients. Diabetic nephropathy seems to be a more significant cause of CKD than was previously reported. Late presentation of patients to nephrologists remains an obstacle to improving CKD outcome in Nigeria. There is need for more intensive preventive measures and early intervention.

High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

BackgroundAbortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).MethodsWe used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.ResultsWe analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).ConclusionOur data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.

Sensitivity of a preanaesthesia screening and triage tool in identifying high-risk patients attending the preanaesthesia assessment clinic in a tertiary referral hospital in Sub-Saharan Africa: a diagnostic accuracy study

ObjectivesThe use of preoperative triage questionnaires is an innovative way to mitigate the shortage of anaesthesiologists and to identify and refer high-risk patients early for evaluation. This study evaluates the...

Ten years' experience with bone conduction hearing aids in the Western Cape, South Africa.

Untreated conductive and mixed hearing losses as a result of middle ear pathology or congenital ear malformations can lead to poor speech, language and academic outcomes in children. Lack of access to centralised hearing healthcare in resource-constrained environments limits opportunities for children with hearing loss. Red Cross War Memorial Children's Hospital (RCWMCH) is one of only two dedicated paediatric hospitals in sub-Saharan Africa. Between 2016 and 2021, 29 children received implanted bone conduction hearing devices, and 104 children were fitted with bone conduction devices on softbands. The authors' experience at RCWMCH suggests that bone-anchored hearing devices, either fitted on softbands or on implanted abutments, can provide solutions in settings where patients have limited access to hearing healthcare and optimal classroom environments. Hearing healthcare should be accessible and delivered at the appropriate level of care to mitigate the adverse effects of hearing loss in children.Contribution:This article describes strategies employed at RCWMCH such as fitting bone conduction hearing devices on a softband immediately after hearing loss diagnosis and conducting follow-up via remote technology to make hearing healthcare more accessible to vulnerable populations.

A review of outcomes of laser photocoagulation for Goldberg stage 3 proliferative sickle cell retinopathy

Topic: A review of outcomes of laser photocoagulation for Goldberg stage 3 proliferative sickle cell retinopathy (PSR) in a Eye Foundation Hospital. Aims and objectives: To report regression of retina neovascularization and visual outcomes after prophylactic scatter retina laser photocoagulation for Goldberg stage 3 PSR in a tertiary private hospital in sub-Saharan Africa. Methods: A retrospective review of case files of patients who were treated with prophylactic scatter retina laser photocoagulation between January 2017 and June 2022 following a diagnosis of PSR in a Eye Foundation Hospital, Ikeja, Lagos, Nigeria, was done. Results: A total of 124 eyes of 62 patients with PSR were seen within the period under consideration. A majority of patients (49 (79.0%)) had hemoglobin (Hb) genotype SC, while 13 patients (21%) were Hb genotype SS. At presentation, 29 eyes (23.3%) had Goldberg stage 2 PSR, 55 eyes (44.4%) had Goldberg stage 3 PSR, 27 eyes (21.8%) had stage 4 PSR, while 13 eyes (10.5%) had stage 5 PSR. All 55 eyes (49.2%) with stage 3 PSR were treated with prophylactic retina laser photocoagulation. At the patients’ last clinic visit, 34 eyes (61.8%) had the same visual acuity (VA) as at presentation, 11 eyes (20%) had improvements in VA, while 10 eyes (18.2%) had worse VA. Laser treatment success (regression of seafan neovascularization) was seen in 50 eyes (90.9%), while five eyes (8.1%) had unsuccessful laser treatment. Conclusion: A high percentage (90.9%) of resolution of retina neovascularization secondary to PSR at stage 3 of Goldberg’s classification was seen after prophylactic scatter retina laser photocoagulation in our group of evaluated patients. Most patients (81.8%) maintained or had improvements in their visual acuities over the period of follow-up. More clinical research is required to further evaluate outcomes of laser photocoagulation for PSR.

Methodological reflections on health system-oriented assessment of maternity care in 16 hospitals in sub-Saharan Africa: an embedded case study.

Health facility assessments (HFAs) assessing facilities' readiness to provide services are well-established. However, HFA questionnaires are typically quantitative and lack depth to understand systems in which health facilities operate-crucial to designing context-oriented interventions. We report lessons from a multiple embedded case study exploring the experiences of HFA data collectors in implementing a novel HFA tool developed using systems thinking approach. We assessed 16 hospitals in four countries (Benin, Malawi, Tanzania and Uganda) as part of a quality improvement implementation research. Our tool was organized in 17 sections and included dimensions of hospital governance, leadership and financing; maternity care standards and procedures; ongoing quality improvement practices; interactions with communities and mapping of the areas related to maternal care. Data for this study were collected using in-depth interviews with senior experts who conducted the HFA in the countries 1-3months after completion of the HFAs. Data were analysed using the inductive thematic analysis approach. Our HFA faced challenges in logistics (accessing key hospital-based respondents, high turnover of managerial staff and difficulty accessing information considered sensitive in the context) and methodology (response bias, lack of data quality and data entry into an electronic platform). Data elements of governance, leadership and financing were the most affected. Opportunities and strategies adopted aimed at enhancing data collection (building on prior partnerships and understanding local and institutional bureaucracies) and enhancing data richness (identifying respondents with institutional memory, learning from experience and conducting observations at various times). Moreover, HFA data collectors conducted abstraction of records and interviews in a flexible and adaptive way to enhance data quality. Lessons and new skills learned from our HFA could be used as inputs to respond to the growing need of integrating the systems thinking approach in HFA to improve the contextual understanding of operations and structure.

Every breath counts: Lessons learned in developing a training NICU in Northern Tanzania.

IntroductionNeonatal mortality rates in resource-limited hospitals of Sub-Saharan Africa (SSA) remain disproportionately high and are likely underestimated due to misclassification of extremely preterm births as “stillbirths” or “abortions”, incomplete death registries, fear of repercussions from hospital and governmental authorities, unrecorded village deaths, and cultural beliefs surrounding the viability of premature newborns. While neonatology partnerships exist between high income countries and hospitals in SSA, efforts have largely been directed toward improving newborn survival through neonatal resuscitation training and provision of equipment to nascent neonatal intensive care units (NICUs). These measures are incomplete and fail to address the challenges which NICUs routinely face in low-resource settings. We draw on lessons learned in the development of a low-technology referral NICU in Tanzania that achieved an overall 92% survival rate among infants.Lessons learnedAchieving high survival rates among critically ill and preterm neonates in SSA is possible without use of expensive, advanced-skill technologies like mechanical ventilators. Evidence-based protocols adapted to low-resource hospitals, mentorship of nurses and physicians, changes in hierarchal culture, improved nurse-infant staffing ratios, involvement of mothers, improved procurement of consumables and medications, and bedside diagnostics are necessary steps to achieving high survival rates. Our NICU experience indicates that low-technology solutions of thermoregulation, respiratory support via continuous positive airway pressure, feeding protocols and infection control measures can ensure that infants not only survive, but thrive.ConclusionsNeonatal mortality and survival of preterm newborns can be improved through a long-term commitment to training NICU staff, strengthening basic neonatal care practices, contextually appropriate protocols, and limited technology.

The prediction of early mortality by the ROX index of oxygenation and respiratory rate in diverse Canadian and Ugandan cohorts of unselected patient: a post-hoc retrospective analysis of 80,558 patient observations.

To investigate the association between in-hospital mortality and the ROX index of respiratory rate and oxygenation in diverse cohorts of unselected patient at different prediction windows. A retrospective post-hoc analysis of data from a major regional referral Canadian hospital and a low-resource hospital in sub-Saharan Africa. Four patient cohorts were examined: Canadian medical, surgical and intensive care unit (ICU) patients, and all patients admitted to an African hospital. In all patients in-hospital mortality rose as ROX declined. Apart from ICU patients, ROX had a high discrimination for death within 72 hours. For non-ICU patients the negative predictive value of death within 72 hours for a ROX value <22 ranged from 0.994 to 1.000 Conclusion: In diverse cohorts of unselected patients, the ROX index has a high discrimination for death within 72 hours. However, the index has little or no prognostic value for patient admitted to ICU.

Antimicrobial resistance including Extended Spectrum Beta Lactamases (ESBL) among E. coli isolated from kenyan children at hospital discharge.

BackgroundChildren who have been discharged from hospital in sub-Saharan Africa remain at substantial risk of mortality in the post-discharge period. Antimicrobial resistance (AMR) may be an important factor. We sought to determine the prevalence and risk factors associated with AMR in commensal Escherichia coli (E. coli) from Kenyan children at the time of discharge.Methodology/Principle findingsFecal samples were collected from 406 children aged 1–59 months in western Kenya at the time of discharge from hospital and cultured for E. coli. Susceptibility to ampicillin, ceftriaxone, cefotaxime, ceftazidime, cefoxitin, imipenem, ciprofloxacin, gentamicin, combined amoxicillin/clavulanic acid, trimethoprim-sulfamethoxazole, azithromycin, and chloramphenicol was determined by disc diffusion according to guidelines from the Clinical and Laboratory Standards Institute (CLSI). Poisson regression was used to determine associations between participant characteristics and the presence of extended-spectrum beta-lactamases (ESBL) producing E. coli. Non-susceptibility to ampicillin (95%), gentamicin (44%), ceftriaxone (46%), and the presence of ESBL (44%) was high. Receipt of antibiotics during the hospitalization was associated with the presence of ESBL (aPR = 2.23; 95% CI: 1.29–3.83) as was being hospitalized within the prior year (aPR = 1.32 [1.07–1.69]). Open defecation (aPR = 2.02; 95% CI: 1.39–2.94), having a toilet shared with other households (aPR = 1.49; 95% CI: 1.17–1.89), and being female (aPR = 1.42; 95% CI: 1.15–1.76) were associated with carriage of ESBL E. coliConclusions/SignificanceAMR is common among isolates of E. coli from children at hospital discharge in Kenya, including nearly half having detectable ESBL.

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six...

Nurses' perceptions of quality of work life in private hospitals in Enugu, Nigeria: A qualitative study

Despite being essential for retaining nurses, not much is known about nurses' quality of work life (QWL) in private hospitals in sub-Saharan Africa, including Nigeria. We explored nurses' perceptions of QWL, factors influencing it, how it affects motivation, and strategies for its improvement. The study was conducted in seven private hospitals in Enugu, Nigeria. The design was qualitative, using focus group discussion (n = 7) with registered nurses (n = 66) purposively selected using maximum variation sampling and the inclusion criteria. Data were analyzed using verbatim transcription and thematic analysis. The nurses understood QWL from work-family life, work design, work context and work world perspectives. Opportunities for skill acquisition, resource availability, helpfulness from colleagues, and a hygienic work environment improved the QWL and motivation of nurses. Work-family life factors including caring obligations, night shifts, long hours, burnout, and inappropriate leave policies; work design factors including declining autonomy, inadequate staffing, and a high workload; work context factors consisting of a lack of participatory decision-making, blaming nurses for gaps, restrictive training policy, limited training opportunity, and insecurity; and work world factors related to poor remuneration, poor community view of nursing and ease of job termination undermined QWL and demotivated nurses. Strategies identified by the nurses to improve QWL included improving staffing, vacation, care coordination, supportive supervision, teamwork, promotion, participatory decision-making, training opportunities, timely hand-over of shifts, job recognition, and compensation. The quality of nursing work life in private hospitals in Enugu needs improvement. Quality improvement programs addressing the barriers to nurses' QWL are warranted.

Trauma unit management and outcomes at an urban tertiary hospital in sub-Saharan Africa: a descriptive study.

Injuries are a neglected burden despite accounting for 9% of deaths worldwide which is 1.7 times that of hiv, tb and malaria combined. Trauma remains overlooked as research and resources are focused on infectious diseases. Uganda with limited trauma epidemiological data has one of the highest traumatic injury rates. This study describes demographics, management and outcomes of patients admitted to mulago hospital trauma unit. This study was a retrospective record review from july 2012 to december 2015. A data collected included age, time and vitals of admission plus interventions, management and outcomes after which it was analyzed. 834 patient records were reviewed. The predominant age group was 18-35 and 86% of the patients were male. 54% of the patients presented during day and majority of the admission had gcs of less than 8. Antibiotics were given to 467 patients with mechanical ventilation (301) and intubation (289) as the frequent interventions done. 52% of admitted patients were discharged and 40% died. Most admissions' were of youthful age and had severe head injuries (gcs<8). 56% received antibiotics with frequent interventions beig mechanical ventilation and intubation. 52% of admitted patients were discharged and 40% died.

Hospital Mortality in Trauma Patients

Introduction: The study of mortality in a community makes it possible to define the axes of disease prevention and to readjust public health policies. The achieve of our study was to assess hospital mortality in trauma patients in an orthopedic department of a teaching hospital in sub-Saharan Africa. Patients and Method: We conducted a retrospective prognostic study evaluating hospital mortality during the period from March 1, 2013 to February 29, 2018. The results were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: Hospital mortality rate was 1.43%. The Circumstances of death were dominated by road accidents with 48.2%. Trauma to the lower limbs, the spine and polytrauma were the most frequently observed lesions on admission of patients with 40%, 27.3% and 28.2% respectively. Neurovegetative complications (29.51 %) and cardiopulmonary arrest (18.03 %) were the main causes of death at autopsy. Results: Hospital mortality rate was 1.43%. The Circumstances of death were dominated by road accidents with 48.2%. Trauma to the lower limbs, the spine and polytrauma were the most frequently observed lesions on admission of patients with 40%, 27.3% and 28.2% respectively. Neurovegetative complications (29.51 %) and cardiopulmonary arrest (18.03 %) were the main causes of death at autopsy. Conclusion: Traffic accidents are the most common cause of death from trauma. They can be avoided or limited by a good road safety policy.

Integration of mHealth Information and Communication Technologies Into the Clinical Settings of Hospitals in Sub-Saharan Africa: Qualitative Study.

BackgroundThere is a rapid uptake of mobile-enabled technologies in lower- and upper-middle–income countries because of its portability, ability to reduce mobility, and facilitation of communication. However, there is limited empirical evidence on the usefulness of mobile health (mHealth) information and communication technologies (ICTs) to address constraints associated with the work activities of health care professionals at points of care in hospital settings.ObjectiveThis study aims to explore opportunities for integrating mHealth ICTs into the work activities of health care professionals at points of care in clinical settings of hospitals in Sub-Saharan Africa. Thus, the research question is, “How can mHealth ICTs be integrated into the work activities of health care professionals at points of care in hospital settings?”MethodsA qualitative approach was adopted to understand the work activities and points at which mHealth ICTs could be integrated to support health care professionals. The techniques of inquiry were semistructured interviews and co-design activities. These techniques were used to ensure the participation of frontline end users and determine how mHealth ICTs could be integrated into the point of care in hospital settings. Purposive and snowball sampling techniques were used to select tertiary hospitals and participants for this study from South Africa and Nigeria. A total of 19 participants, including physicians, nurses, and hospital managers, were engaged in the study. Ethical clearance was granted by the University research committee and the respective hospitals. The data collected were sorted and interpreted using thematic analysis and Activity Analysis and Development model.ResultsThe findings show that mHealth ICTs are suitable at points where health care professionals consult with patients in the hospital clinics, remote communication is needed, and management of referrals and report writing are required. It was inferred that mHealth ICTs could be negatively disruptive, and some participants perceived the use of mobile devices while engaging with patients as unprofessional. These findings were informed by the outcomes of the interplay between human attributes and technology capabilities during the transformation of the motives of work activity into the intended goal, which is enhanced service delivery.ConclusionsThe opportunities to integrate mHealth ICTs into clinical settings depend on the inefficiencies of interaction moments experienced by health care professionals at points of care during patient consultation, remote communication, referrals, and report writing. Thus, the timeliness of mHealth ICTs to address constraints experienced by health care professionals during work activities should take into consideration the type of work activity and the contextual factors that may result in contradictions in relation to technology features. This study contributes toward the design of mHealth ICTs by industry vendors and its usability evaluation for the work activity outcomes of health care professionals.

Treatment abandonment: A report from the collaborative African network for childhood cancer care and research-CANCaRe Africa.

'Treatmentabandonment' is a common and preventable cause of childhood cancer treatment failure in low- and middle-income countries (LMIC). Risk factors and effective interventions in LMIC are reported. Poverty and costs of treatment are perceived as overriding causes in sub-Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub-Saharan Africa, to be better informed for planned future interventions. A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub-Saharan Africa. Children younger than 16years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3months of treatment. We included 252 patients (median age 6.0, range 0.2-15.0years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p=.026). Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub-Saharan Africa.

Surgical care in district hospitals in sub-Saharan Africa: a scoping review

ObjectiveTo provide a general overview of the reported current surgical capacity and delivery in order to advance current knowledge and suggest targets for further development and research within the region...