Medicines In sub-Saharan Africa Research Articles

Syphilis, blanchiment and French colonial medicine in sub-Saharan Africa during the interwar period.

During the interwar period, France put unprecedented efforts into public health measures targeting the colonised populations of sub-Saharan Africa. This investment in health was seen as crucial to ensuring the renewal of the African labour force needed for the economic development of the colonies. Syphilis, although less deadly than other endemic or epidemic diseases such as yellow fever, sleeping sickness and bubonic plague, was one of the most widespread infections in France's sub-Saharan colonies. This article demonstrates the contradictory nature of the colonial medicine approach to this disease during the interwar years. The negative impact of syphilis on population growth in Africa made it a major threat to the colonial project, and France put significant, costly investment into tackling the disease, focusing its efforts on maternal and child health. However, a closer look at syphilis control in sub-Saharan Africa reveals that the disease was also minimised as a public health issue, under-resourced and downplayed by colonial doctors and administrators. This neglect was embodied in the invention of a new colonial disease, 'exotic syphilis', which was presented as being a relatively benign skin disease among the African populations. It was also reflected in care practices, via a form of mass medicine based on the use of blanchiment, which consisted of knowingly limiting treatment to a superficial effect.

Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review.

Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization's Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA. A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework. The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices. This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.

The meaning of caring for patients with cancer among traditional medicine practitioners in Uganda: A grounded theory approach.

Traditional medicine practitioners (TMPs) are a critical part of healthcare systems in many sub-Saharan African countries and play vital roles in caring for patients with cancer. Despite some progress in describing TMPs' caring experiences in abstract terms, literature about practice models in Africa remains limited. This study aimed to develop a substantive theory to clarify the care provided by TMPs to patients with cancer in Uganda. This study adhered to the principal features of the modified Straussian grounded theory design. Participants were 18 TMPs caring for patients with cancer from 10 districts in Uganda, selected by purposive and theoretical sampling methods. Researcher-administered in-depth interviews were conducted, along with three focus group discussions. Data were analyzed using constant comparative analysis. The core category that represented TMPs' meaning of caring for patients with cancer was "Restoring patients' hope in life through individualizing care." TMPs restored patients' hope through five main processes: 1) ensuring continuity in the predecessors' role; 2) having full knowledge of a patient's cancer disease; 3) restoring hope in life; 4) customizing or individualizing care, and 5) improving the patient's condition/health. Despite practice challenges, the substantive theory suggests that TMPs restore hope for patients with cancer in a culturally sensitive manner, which may partly explain why patients with cancer continue to seek their services. The findings of this study may guide research, education, and public health policy to advance traditional medicine in sub-Saharan Africa.

Blood as an Important Tool in Forensic Medicine in Sub-Saharan Africa: Nigeria as a Perception

Blood is one of the most important biological tools in forensic medicine used to resolve and investigate crime-related cases because it contains useful details. It entails an analysis of various aspects of bloodstains that contribute to the clarification of some violent criminal cases. The knowledge of forensic medicine is essential to provide answers about a series of events and mechanisms of the creation of specific groups of bloodstains on the crime scene. This includes investigation towards the analysis of bloodstains. This knowledge enables the interpretation of results and makes it possible to get closer to the truth, solve particular crimes and ensure accuracy in the legal determination of criminal offences which helps in a proper penalty when making a judgment for the offender

Efforts at building capacity for manufacturing and testing the quality of medicines in Sub-Saharan Africa: Historical evidence from the BIRS programme

Background: Some countries in sub-Saharan Africa combat the proliferation of substandard medicines using anti-counterfeiting devices. An alternative measure involves advanced pharmaceutical education. The Biotechnology Innovation and Regulatory Science (BIRS) educate students in pharmaceutical Good Manufacturing Practices (GMP) and quality control (QC). Objective: This study assessed the African BIRS programme’s efforts to initiate and sustain the manufacturing of quality medicines. Method: Qualitative case studies were used to assess the impact of the BIRS professional training intervention. A convenient purposeful sample of alumni students working in pharmaceutical manufacturing and quality control (QC) participated. Quantitative parametric methods were used to test the hypothesis that participants would significantly increase over the years if the programme met its objectives in the region. Results: Alumni from ten countries implemented and sustained projects in Good Manufacturing Practice (GMP) and QC. Participants from 2016 (17 males, 8 females) and 2018 (14 males, 8 females) increased in year 2020 (31 males, 22 females), p-values < 0.05, α = 0.05. Conclusion: Advanced education has improved efforts in maintaining quality healthcare in the region.

In Vitro Antioxidant and Anticancer Properties of Various E. senegalensis Extracts.

Although Erythrina senegalensis is a plant widely used in traditional medicine in sub-Saharan Africa, its biological properties have been poorly investigated to date. We first characterized by conventional reactions the composition of several stem bark extracts and evaluated in acellular and cellular assays their pro- or antioxidant properties supported by their high phenolic and flavonoid content, particularly with the methanolic extract. The pro- or antioxidant effects observed did not correlate with their IC50 concentrations against five cancer cell lines determined by MTT assay. Indeed, the CH2Cl2 extract and its ethyl acetate (EtOAc) subfraction appeared more potent although they harbored lower pro- or antioxidant effects. Nevertheless, at equipotent concentration, both extracts induced ER- and mitochondria-derived vacuoles observed by fluorescent microscopy that further led to non-apoptotic cell death. LC coupled to high resolution MS investigations have been performed to identify chemical compounds of the extracts. These investigations highlighted the presence of compounds formerly isolated from E. senegalensis including senegalensein that could be retrieved only in the EtOAc subfraction but also thirteen other compounds, such as 16:3-Glc-stigmasterol and hexadecanoic acid, whose anticancer properties have been previously reported. Nineteen other compounds remain to be identified. In conclusion, E. senegalensis appeared rich in compounds with antioxidant and anticancer properties, supporting its use in traditional practice and its status as a species of interest for further investigations in anticancer drug research.

Traditional Medicine Utilisation Among Pregnant Women in Sub-saharan African Countries: A Systematic Review of Literature.

Traditional medicine has the potential to boost the health and economies of many SSA countries, especially if regulatory mechanisms are deployed to govern their protection and utilisation. There is lack of knowledge regarding traditional medicines and their impact on pregnancy. This paper reviews the literature on traditional medicine utilisation among pregnant women in Sub-Saharan African countries. The paper, determined the proportion of pregnant women utilising traditional medicines in Sub-Saharan Africa, identified the different types of traditional medicine used during antenatal care and reasons for Use in Sub-Saharan Africa and also identified challenges that are faced by women who use traditional medicine in antenatal care. A systematic exploratory review was conducted guided by the PRISMA framework. The databases that were searched included Google Scholar, PubMed, Cochrane, HINARI and the World Health Organization. Forty-one literature sources were eligible and included in the review process. Reported traditional medicine utilisation ranged between 12 and 93% among pregnant women in Sub-Saharan Africa. Different types of traditional medicines have been utilised in Sub-Saharan Africa for different purposes. Safety and poor management of usage were reported to be some of the challenges associated with traditional medicine. There is a need to determine chemical components and mode of action of these herbs as some could be beneficial, whilst others harmful, leading to severe pregnancy complications.

Emergency compounding of COVID-19 medicines: A readiness programme to up-skill pharmacy graduates in Namibia

Background: The COVID-19 pandemic has exacerbated inequitable access to medicines in sub-Saharan Africa, mainly due to limited capabilities for local manufacture. Aim: To describe priority medicine lists and critical skill sets required for an emergency compounding of COVID-19 medicines training programme. Methods: An evaluation of the COVID-19 emergency compounding readiness programme for the University of Namibia pharmacy graduates. The main outcomes were enhanced skill sets in compounding, quality control, and regulation of priority COVID-19 medicines. Data on outcomes were thematically analysed. Results: Fifty- eight pharmacy graduates demonstrated competence in emergency compounding, quality control, regulation, and provision of therapeutic information of COVID-19 medicines. A priority list and a skills set for emergency compounding of COVID-19 medicines were developed. Conclusions: The upskilling of pharmacy graduates on emergency compounding of COVID-19 medicines has the potential to address inequalities in the rapid response and control of epidemics.

Design and Implementation of a Distant-Learning Clinical Research Mentorship Program: The Accra-Toronto Collaboration.

PURPOSEFor many oncology training programs in low- and middle-income countries, dedicated time for research education and mentorship of trainees is limited. Here, we report a 1-year–long collaboration between a cancer center in Canada and one in Ghana with the aim of imparting clinical research skills and mentoring the research of radiation oncology residents.METHODSOn the basis of a needs assessment conducted in Ghana, we designed a curriculum consisting of 13 weekly seminars delivered via videoconference, followed by a 1-year–long mentorship program to support research projects. The primary outcome was the feasibility of the program from seminars to manuscript preparation. We used multiple secondary outcomes to capture the learning experience with study-specific questionnaires. We evaluated critical thinking ability using the Berlin questionnaire. Funding was made available for research and travel to international conferences.RESULTSFive Ghanaian trainees submitted research proposals. Nine Canadian faculty members delivered the seminars and two served as methodology mentors, and two Ghanaian faculty acted as local supervisors. Feedback questionnaires from all participants showed that they agreed strongly that they would recommend the sessions to another resident (75%), that the objectives were clear (71%), and that the topics were useful for their training (73%). At the end of the program, two Ghanaian trainees finalized their manuscripts and one was published.CONCLUSIONHere, we report on the implementation of a mentorship program focused on research methods and evidence-based medicine in sub-Saharan Africa. The program was successful in the drafting and publication of abstracts and manuscripts by local trainees.

Family medicine in Tanzania: Seize the moment.

In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC. The paper reviews how PHC is understood, the context of family medicine in sub-Saharan Africa and makes a case for how family medicine can assist in addressing the current burden of disease in Tanzania.

Frequency of Cardiovascular Risk Factors in Systemic Lupus Erythematosus: A Case-Control Study in a Department of Internal Medicine in Sub-Saharan Africa

Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value < 0.05. Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p < 0.001) and uricemia (p < 0.001) were significantly higher in patients. The level of HDL cholesterol (p = 0.028) was lower in cases. Thus, low HDL cholesterolemia (p = 0.001), hypertriglyceridemia (p < 0.001), and hyperuricemia (p = 0.043) were more common in the cases. Renal failure was associated with systemic lupus erythematosus (p < 0.001). Difference in LDL-cholesterol (p = 0.103), hypertension (p = 1) and metabolic syndrome (p = 1) between cases and controls was not significant. Obesity and overweight were predominant in controls (p = 0.028). Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.

A family-level floristic inventory and analysis of medicinal plants used in Traditional African Medicine.

Floristic diversity patterns of medicinal plants in sub-Saharan Africa are compared to global patterns to gain insights into the selection of plants used in Traditional African Medicine. To answer two questions: Firstly, is the selection of medicinal plants used in Traditional African Medicine in sub-Saharan Africa based on availability or is it biased towards certain plant families? Secondly, does the floristic composition of African medicinal plants differ from the global pattern and from other healing systems of the world? Data edited and summarized from recent reviews and on-line databases were compiled into an inventory of all vascular plant families of the world, showing the global numbers of species per family, the numbers of African taxa per family, the numbers of African medicinal plant species per family and the numbers of commonly traded African medicinal plants. These data were subjected to linear regression analyses, as well as Bayesian analysis and Imprecise Probability calculation (using the Imprecise Dirichlet model). At least 4576 vascular plant species from 1518 genera are used in Traditional African Medicine in sub-Saharan Africa, representing 192 families (out of 254 African families). Traditional African Medicine is dominated by Fabaceae (567 spp., 156 genera), Rubiaceae (318 spp., 99 genera), Asteraceae (314 spp., 112 genera), Malvaceae (202 spp., 46 genera), Euphorbiaceae (197 spp., 47 genera), Apocynaceae (167 spp., 68 genera), Lamiaceae (142 spp., 37 genera), Acanthaceae (106 spp., 40 genera), Asparagaceae (90 spp., 18 genera) and Poaceae (85 species, 47 genera). Regression analysis of the African medicinal flora shows that the Fabaceae (576 medicinal species/residual +136), Malvaceae (202/+105), Rubiaceae (318/+85), Lamiaceae (142/+55), Euphorbiaceae (197/+54) and Combretaceae (72/+49) are overused, while Aizoaceae (10/-136), Orchidaceae (34/-127), Iridaceae (16/-101) and Poaceae (85/-87) are underused. Bayesian and IDM analysis showed that a large number of smaller families are also overused and underused. Commonly traded African medicinal plants species are mostly from Fabaceae (27 species), Apocynaceae (16), Burseraceae (12) and Rubiaceae (9). The selection of African medicinal plants appears to be based on availability (for some families) and apparently cultural and other criteria, such as the presence of alkaloids, terpenoids and volatile compounds for others (e.g., Fabaceae, Apocynaceae and Burseraceae). In terms of commercialised species in international trade, Traditional African Medicine differs from the global pattern (and other healing systems) in the dominance of Fabaceae and Apocynaceae and the relatively low numbers of Asteraceae, Lamiaceae, Apiaceae and Rosaceae.

Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance.

This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in Sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale, and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an “entry-level version” of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment.

Improved Adherence to Antiretroviral Therapy Observed Among HIV-Infected Children Whose Caregivers had Positive Beliefs in Medicine in Sub-Saharan Africa

A high level of adherence to antiretroviral treatment is essential for optimal clinical outcomes in HIV infection, but measuring adherence is difficult. We investigated whether responses to a questionnaire eliciting caregiver beliefs in medicines were associated with adherence of their child (median age 2.8 years), and whether this in turn was associated with viral suppression. We used the validated beliefs in medicine questionnaire (BMQ) to measure caregiver beliefs, and medication event monitoring system caps to measure adherence. We found significant associations between BMQ scores and adherence, and between adherence and viral suppression. Among children initiating Antiretroviral therapy (ART), we also found significant associations between BMQ ‘necessity’ scores, and BMQ ‘necessity-concerns’ scores, and later viral suppression. This suggests that the BMQ may be a valuable tool when used alongside other adherence measures, and that it remains important to keep caregivers well informed about the long-term necessity of their child’s ART.

Multiple cellular effects of leaf extracts from Parinari curatellifolia.

BackgroundParinari curatellifolia is a prominent plant in folk medicine in Sub-Saharan Africa. The plant decoctions are used to treat various ailments, including the treatment of cancer, pneumonia, fever, microbial infections and anti-inflammation. The aims of the study were to investigate the effects of P. curatellifolia leaf extracts on cell inflammatory and proliferative activity.MethodsParinari curatellifolia fresh leaves were collected from Centenary in Mashonaland Central Province of Zimbabwe. Plant extracts were prepared using methanol, water, acetone and ethanol. Firstly, the effects of the extracts were determined on xanthine oxidase activity. Kinetic constants were determined for the extracts that showed inhibitory effects. Then the effects of Parinari curatellifolia water extract on LPS, menadione and hydrogen peroxide-activated nitric oxide production in RAW 264.7 cells was determined by quantifying the amount of nitrites formed. Finally, the effects of P. curatellifolia on the proliferation of Jurkat-T cells as well as its modulation of cisplatin-induced cell- cytotoxicity was investigated on a Jurkat human T-cell lymphoma cell line.ResultsThere was significant XO inhibitory activity by the ethanol and methanol extracts at 15.6 μg/ml and 3.9 μg/ml respectively. The IC50 determination for allopurinol, ethanol extract and methanol extract were 0.43 μg/ml, 1.38 μg/ml and 2.19 μg/ml respectively. The kinetic results showed that the ethanol and methanol extracts were allosteric inhibitors of XO. The water extract of P. curatellifolia inhibited NO production in RAW cells when LPS was used as an activator. P. curatellifolia and cisplatin showed dose-dependent cytotoxicity on Jurkat-T cells. Isolated DNA from the cells showed that there was DNA cleavage on cells exposed to P. curatellifolia indicating that apoptosis may be a mechanism by which P. curatellifolia exerts its cytotoxicity on Jurkat-T cells.ConclusionsThese results scientifically support the use of P. curatellifolia leaf extracts in the management of pain, inflammatory and neoplastic conditions. P. curatellifolia thus has multiple biological effects, thus, validating its use in traditional medical uses.

The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia.

ObjectiveTo characterize the impact of widespread inventory management policies on stock-outs of essential drugs in Zambia’s health clinics and develop related recommendations.MethodsDaily clinic storeroom stock levels of artemether-lumefantrine (AL) products in 2009–2010 were captured in 145 facilities through photography and manual transcription of paper forms, then used to determine historical stock-out levels and estimate demand patterns. Delivery lead-times and estimates of monthly facility accessibility were obtained through worker surveys. A simulation model was constructed and validated for predictive accuracy against historical stock-outs, then used to evaluate various changes potentially affecting product availability.FindingsWhile almost no stock-outs of AL products were observed during Q4 2009 consistent with primary analysis, up to 30% of surveyed facilities stocked out of some AL product during Q1 2010 despite ample inventory being simultaneously available at the national warehouse. Simulation experiments closely reproduced these results and linked them to the use of average past monthly issues and failure to capture lead-time variability in current inventory control policies. Several inventory policy enhancements currently recommended by USAID | DELIVER were found to have limited impact on product availability.ConclusionsInventory control policies widely recommended and used for distributing medicines in sub-Saharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions. Developing central capabilities in peripheral demand forecasting and inventory control is critical. More rigorous independent peer-reviewed research on pharmaceutical supply chain management in low-income countries is needed.

Raspberry Pi and Sensor Networking for African Health Supply Chains

Many medicines in Sub-Saharan Africa lose their effectiveness along the supply chain. Some of the reasons are poor information flows, lack of temperature control systems as well as missing standardized processes including the measurement through performance indicators. Studies from the World Health Organization – executed in 70 countries – report that only 29% of these countries meet the minimum recommended standards for temperature control and levels. In order to meet these challenges, efficient and effective ways need to be found. Frequent power outages, low level of education of personnel and a high rate of warehouses without any ITinfrastructure need to be taken into account. This paper focuses on the usage of Raspberry Pis and Arduino (small, simple and low priced computers) in combination with sensor networking. An in-depth literature analysis as well as an onlocation inspection in Cameroon helped to detect the challenges African health supply chain managers face. The study of the possibilities of a Raspberry Pi in combination with Arduino and sensor networking is currently conducted in order to see if these hardware components could help to improve the cold chain challenges of high priced medicines (e.g. vaccines) in developing countries, e.g. in Sub-Saharan Africa. The objective of our research is to identify a fast, low-cost temperature control system in warehouses in developing countries and health supply chains which is easy to implement, to use, to maintain and works effectively (e.g. fast and reliable).

Experiences and Lessons From Implementing Cohort Event Monitoring Programmes for Antimalarials in Four African Countries: Results of a Questionnaire-Based Survey.

IntroductionCohort event monitoring (CEM) is an intensive method of post-marketing surveillance for medicines safety. The method is based on prescription event monitoring, which began in the 1970s, and has since been adapted by WHO for monitoring the safety of medicines used in Public Health Programmes. CEM aims to capture all adverse events that occur in a defined group of patients after starting treatment with a specific medicine during the course of routine clinical practice.ObjectiveThe aims of this study were to describe the experiences of National Pharmacovigilance Centres (NCs) that have used CEM to monitor artemisinin-based combination therapy (ACT) for uncomplicated malaria in the African setting, to raise awareness of some of the challenges encountered during implementation and to highlight aspects of the method that require further consideration.MethodA questionnaire-based survey was conducted to capture the experiences of NCs that have implemented CEM for active post-marketing surveillance of antimalarial medicines in sub-Saharan Africa. Six NCs were identified as having implemented CEM programmes and were invited to participate in the survey; five NCs indicated willingness to participate and were sent the questionnaire to complete.ResultsFour NCs responded to the survey—Ghana, Kenya, Nigeria and Zimbabwe—providing information on the implementation of a total of six CEM programmes. Their experiences indicate that CEM has helped to build pharmacovigilance capacity within the participating NCs and at the monitoring sites, and that healthcare providers (HCPs) are generally willing to participate in implementing the CEM method. All of the programmes took longer than expected to complete: contributing factors included a prolonged enrolment period and unexpectedly slow data entry. All of the programmes exceeded their budget by 11.1–63.2 %. Data management was identified as a challenge for all participating NCs.ConclusionsThe reported experiences of four NCs that have undertaken CEM studies on ACTs indicate that CEM has helped to build pharmacovigilance capacity within NCs and monitoring sites and that HCPs are willing to participate in CEM programmes; however, the method was found to be labour intensive and data management was identified as a challenge. Reducing the workload associated with CEM, particularly in relation to data management, and integrating the method into the routine work of HCPs and NCs should be considered for future implementation.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-015-0331-7) contains supplementary material, which is available to authorized users.

Transfusion Medicine in Sub-Saharan Africa: Conference Summary.

In November 2014, a 3-day conference devoted to transfusion medicine in sub-Saharan Africa was held in Kampala, Uganda. Faculty from academic institutions in Uganda provided a broad overview of issues pertinent to transfusion medicine in Africa. The conference consisted of lectures, demonstrations, and discussions followed by 5 small group workshops held at the Uganda Blood Transfusion Service Laboratories, the Ugandan Cancer Institute, and the Mulago National Referral Hospital. Highlighted topics included the challenges posed by increasing clinical demands for blood, the need for better patient identification at the time of transfusion, inadequate application of the antiglobulin reagent during pretransfusion testing, concern regarding proper recognition and evaluation of transfusion reactions, the expanded role for nurse leadership as a means to improve patient outcomes, and the need for an epidemiologic map of blood usage in Africa. Specialty areas of focus included the potential for broader application of transcranial Doppler and hydroxyurea therapy in sickle cell disease, African-specific guidelines for transfusion support of cancer patients, the challenges of transfusion support in trauma, and the importance of African-centered clinical research in pediatric and obstetric transfusion medicine. The course concluded by summarizing the benefits derived from an organized quality program that extended from the donor to the recipient. As an educational tool, the slide-audio presentation of the lectures will be made freely available at the International Society of Blood Transfusion Academy Web site: http://www.isbtweb.org/academy/.

A Raspberry in Sub-Saharan Africa? Chances and Challenges of Raspberry Pi and Sensor Networking in Humanitarian Logistics

This paper addresses the chances and challenges of humanitarian logistics in Sub-Saharan Africa with a special view on the application of single-board computers – such as the Raspberry Pi – in combination with sensor networking. In this connection the paper deals with the following questions: Which special circumstances in and challenges for Sub-Saharan Africa need to be considered? How can humanitarian logistics contribute to enhance the supply of people in need with food and medicines? Are Raspberry Pi or other single-board computers and their integration into sensor networks adequate solutions for humanitarian logistics and the supply of food and medicines in Sub-Saharan Africa?