Practice In Sub-Saharan Africa Research Articles

Prevalence and Associated Factors to Uvula Cutting on Under Five Children in Amhara Region, Debre Birhan Town, 2016/ 2017

Background: Traditional uvula cutting, a procedure which consists of cutting part or the entire uvula, it is a common practice in sub-Saharan Africa. In Ethiopia, studies conducted so far were very limited and focused on adult TMP. uvula cutting is commonly practiced in the northern part of Ethiopia but rarely seen in Gambela region. Objective: The aim of the study was to assess the prevalence and associated factors on uvula cutting in DBT, in 2015. Methods: A community based cross-sectional study design was conducted from January seven to February eight2015. The data was collected by trained diploma nurses and was analyzed by using EPI-Info 3.5.4,spss version 16 computer software, the result was presented in the form of text, tables, graphs and pi-chart. Result: The prevalence of uvula cutting among under five children was 23.7%. In this study occupational status, house wife, farmer and others like bar tender) and current age of child are significantly associated with the practice of uvula cutting.

Determinants of morbidity associated with infant male circumcision: community-level population-based study in rural Ghana.

Male circumcision services have expanded throughout Africa as part of a long-term HIV prevention strategy. We assessed the effect of type of service provider (formal and informal) and hygiene practices on circumcision-related morbidities in rural Ghana. Population-based, cross-sectional study conducted between May and December 2012 involving 2850 circumcised infant males aged under 12 weeks. Multivariable logistic regression models were adjusted for maternal age, maternal education, income, birthweight and site of circumcision. A total of 2850 (90.7%) infant males were circumcised. Overall, the risk of experiencing a morbidity (defined as complications occurring during or after the circumcision procedure as reported by the primary caregiver) was 8.1% (230). Risk was not significantly increased if the circumcision was performed by informal providers (121, 7.2%) vs. formal health service providers (109, 9.8%) [adjusted odds ratio (aOR) 1.11, 95% CI 0.80-1.47, P = 0.456]. Poor hygiene practices were associated with significantly increased risk of morbidity: no handwashing [148 (11.7%)] (aOR 1.78, 95% CI 1.27-2.52, P = 0.001); not cleaning circumcision instruments [174 (10.6%)] (aOR 1.80, 95% CI 1.27-2.54, P = 0.001); and uncleaned penile area [190 (10.0%)] (aOR 1.84, 95% CI 1.25-2.70, P = 0.002). The risk of morbidity after infant male circumcision in rural Ghana is high, chiefly due to poor hygiene practices. Governmental and non-governmental organisations need to improve training of circumcision providers in hygiene practices in sub-Saharan Africa.

How innovative and conventional curricula prepare medical students for practice in Sub-Saharan Africa: A comparative study from Mozambique

Medical education in Sub-Saharan Africa is in need of reform to promote the number and quality of physicians trained. Curriculum change and innovation in this region, however, face a challenging context that may affect curriculum outcomes. Research on outcomes of curriculum innovation in Sub-Saharan Africa is scarce. We investigated curriculum outcomes in a Sub-Saharan African context by comparing students' perceived preparedness for practice within three curricula in Mozambique: a conventional curriculum and two innovative curricula. Both innovative curricula used problem-based learning and community-based education. We conducted a comparative mixed methods study. We adapted a validated questionnaire on perceived professional competencies and administered it to 5th year students of the three curricula (n = 140). We conducted semi-structured interviews with 5th year students from these curricula (n = 12). Additional contextual information was collected. Statistical and thematic analyses were conducted. Perceived preparedness for practice of students from the conventional curriculum was significantly lower than for students from one innovative curriculum, but significantly higher than for students from the other innovative curriculum. Major human and material resource issues and disorganization impeded the latter's sense of preparedness. Both innovative curricula, however, stimulated a more holistic approach among students toward patients, as well an inquiring and independent attitude, which is valuable preparation for Sub-Saharan African healthcare. In Sub-Saharan Africa, risks and benefits of curriculum innovation are high. Positive outcomes add value to local healthcare in terms of doctors' meaningful preparedness for practice, but instead outcomes can be negative due to the implementation challenges sometimes found in Sub-Saharan African contexts. Before embarking on innovative curriculum reform, medical schools need to assess their capability and motivation for innovation.

Evaluation of Blood Transfusions in Anemic Children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana.

Blood transfusion is a common practice in sub-Saharan Africa as a way of correcting anemia in children with mild and severe sicknesses. This study evaluated this practice in a secondary health-care institution in Ghana. A retrospective study was done over a 3-year period from January 2010 to December 2012. Medical records of children admitted, successfully treated, and discharged from the hospital were collected and analyzed. Data were analyzed using Epi Info version 7. Transfusions were more among male children (89, 63.1%) than female children (52, 36.9%). The highest number of blood transfusions were carried out on children in the age range 0-1 year (66, 46.8%). The majority of the blood transfusions were done on children with hemoglobin concentration level of 5 g/dL and below. Children with malaria parasitemia (83, 58.9%) had more transfusions than children without malaria parasitemia (58, 41.1%). Fever alone (43, 30.5%) and fever with gastrointestinal symptoms (33, 23.4%) were the predominant symptoms among children who had blood transfusions. In conclusion, younger children received more transfusions than older children. Also, male children received more blood transfusions than female children. Malaria was observed as a major contributory factor to the requirement for blood transfusions among the children.

Prognosis of Syntocinon Infusion on Scar Uterus Cotonou-Benin

Objective: This study aims to assess prognosis of actively managed childbirths through oxytocin infusion into uterus with prior caesarean section in the Lagoon University Teaching Hospital for Mother and Child (CHU-MEL). Method: It was a case control study of descriptive and analytical type based on 82 observations of actively managed delivery with oxytocin infusion into uterus with caesarean section scar at the Maternity over a two-year period from February 1, 2014 to December 31, 2015. Results: Actively managed childbirth with oxytocin accounted for 8.4% of childbirths through uterus with Csection scar; success rate was 79.3%. Caesarean section was necessary for delivery in 19.5% of the cases. The mean age of our parturient women was 29.5 years. The mean pregnancy bearing rate of parturient women was 3.5 pregnancies with extremes of 2 and 7 pregnancies. Most parturient women had an inter delivery interval between 2 and 5 years i.e. a 78%. The surgical outcomes of first caesarean section were not characterized by any particularity. In this research work, we did not note any case of maternal death, but we registered 1 case of uterine rupture (1.2%). We also registered 3 neonatal deaths, i.e. a 3.6% rate including 1 death after vaginal birth i.e. 1.2%. These deaths were due to uterine rupture (1 case) and neonatal distress (2 cases). Conclusion: Despite all the constraints of obstetrical practice in Sub-Saharan Africa, using Oxytocin may be contemplated for the management of labor on uterus with c-section scar.

Local contraceptive practice in Sub-Saharan Africa

Although modern contraceptive options are becoming more widely available, even in the developing world, women still use traditional contraceptive methods. Other reports of the use of non-medical devices for contraception and abortion are available. With this report, we discuss a patient seeking treatment for the removal of a traditional contraceptive intrauterine device.

Association between women's empowerment and infant and child feeding practices in sub-Saharan Africa: an analysis of Demographic and Health Surveys.

To explore the relationship between women's empowerment and WHO recommended infant and young child feeding (IYCF) practices in sub-Saharan Africa. Analysis was conducted using data from ten Demographic and Health Surveys between 2010 and 2013. Women's empowerment was assessed by nine standard items covering three dimensions: economic, socio-familial and legal empowerment. Three core IYCF practices examined were minimum dietary diversity, minimum meal frequency and minimum acceptable diet. Separate multivariable logistic regression models were applied for the IYCF practices on dimensional and overall empowerment in each country. Benin, Burkina Faso, Ethiopia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Uganda and Zimbabwe. Youngest singleton children aged 6-23 months and their mothers (n 15 153). Less than 35 %, 60 % and 18 % of children 6-23 months of age met the criterion of minimum dietary diversity, minimum meal frequency and minimum acceptable diet, respectively. In general, likelihood of meeting the recommended IYCF criteria was positively associated with the economic dimension of women's empowerment. Socio-familial empowerment was negatively associated with the three feeding criteria, except in Zimbabwe. The legal dimension of empowerment did not show any clear pattern in the associations. Greater overall empowerment of women was consistently and positively associated with multiple IYCF practices in Mali, Rwanda and Sierra Leone. However, consistent negative relationships were found in Benin and Niger. Null or mixed results were observed in the remaining countries. The importance of women's empowerment for IYCF practices needs to be discussed by context and by dimension of empowerment.

AIDS and rural livelihoods: Dynamics and diversity in sub–Saharan Africa

HIV and AIDS continue to devastate the livelihoods of millions of Africans and represent the major public health challenge in many countries. More people die of AIDS each day than from wars, famine and floods combined, while an orphaned generation of children must be provided for. Yet despite millions of dollars of aid and research, there has previously been little detailed on-the-ground analysis of the long-term impact on rural people. This book brings together recent evidence on HIV/AIDS impacts on rural households, livelihoods, and agricultural practice in sub-Saharan Africa. There is particular emphasis on the role of women in affected households. The book presents micro-level information collected by original empirical research in a range of African countries, and shows how well-grounded conclusions on trends and major problems can then be addressed by policies. It is shown that HIV/AIDS impacts are more diverse than we know (and not always negative) on the basis of cumulative evidence so far.

The Effect of Training on Traditional Birth Attendants' PMTCT Related Knowledge and Care Practices in Nigeria

Introduction: As much as 60% of children born in Nigeria are delivered by unskilled traditional birth attendants. It imperative for traditional birth attendants and similar cadre of health care providers in resource-limited settings to be knowledgeable and have the ability to deploy evidence based practices in the prevention of mother to child transmission of HIV if the goal of an AIDS free generation will be achieved. The successful linkage of evidence with practice in sub-Saharan Africa and other resource limited settings will translate into the reduction of MTCT of HIV as has been achieved in other parts of the world. Methods: A cross-sectional survey of 142 traditional birth attendants. The research was based on diffusion of innovation theory. Practices related to prevention of mother to child transmission of HIV were evaluated relative to national guidelines. Linear mixed modelling was used to evaluate the association between PMTCT practices and training on prevention of mother to child transmission of HIV. Results: Most traditional birth attendants were knowledgeable and had good practices relating to prevention of mother to child transmission of HIV. However, significant gaps in HIV exposed infant care; infant feeding practices and harmful traditional practices exist. Conclusions: Traditional birth attendants have a role in the prevention of mother to child transmission of HIV. Evidence-based practices that are related to maternal HIV transmission are being taken from research and policy into patient care domains; though there are some gaps in vital practices. Innovative strategic interventions are very essential to enhance participation of TBAs in the PMTCT of HIV.

Relevance of clinical auto psy in medical practice in Sub-Saharan Africa

Autopsy is very important in medical practice and is being increasingly relegated both in the developed and developing countries. Though autopsy rate has been on the decline, the exact rates are difficult to determine because various reports are influenced by many factors. The danger of the decline in the developing countries is that equipment for proper diagnosis is not yet available, therefore, most diagnoses are not made and the cause of death would not have been known. This article reviews the benefits of autopsy in modern practice, the importance of perinatal autopsy and the shortcomings of modern technology in the diagnosis and determination of the cause of death. Electronic literature search combined with the review of both local publications and relevant texts were carried out. Clinicians should endeavor to request for postmortem examination as the benefits far outweigh the reasons proffered for the decline in the autopsy rate.

Students’ and junior doctors’ preparedness for the reality of practice in sub-Saharan Africa

Background: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region.Aim: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context.Methods: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model.Results: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors’ motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work.Conclusion: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors’ motivation and preparedness to tackle the challenges of health care practice in this region.

Effect of Delayed Cassava Planting on Yields and Economic Returns of a Cassava-Groundnut Intercrop in the Democratic Republic of Congo

Cassava intercropping is a common practice in sub-Saharan Africa. In terms of growth pattern, canopy development and nutrient demand, grain legumes are well suited for intercropping with cassava. Due to the inter-specific competition for growth resources, the relative planting time of the component crops has been considered as one of the important management practices for intercropping system productivity. Little information exists on the effect of cassava planting time on yields and economic returns of a cassava-legume intercrop. This study investigated the effect of relative planting times of cassava on yields and economic returns of a cassava-groundnut intercrop. Researcher-managed, field trials were installed in Bas-Congo Province in two consecutive seasons using four different planting times of cassava after the groundnuts. The results indicated that cassava planting time did not affect both grain and biomass yields of groundnut. When cassava was planted 3 weeks after the groundnuts, cassava storage root yields were significantly (P = 0.029) decreased by 48 to 60 % (9.3 to 11.3 t ha-1) over cassava planted at the same time as groundnut. The net revenue of cassava planted 3 weeks after the groundnut was significantly (P = 0.002) decreased by about 70 % over that of cassava planted at the same time or 2 weeks after the groundnuts. Maximum net revenue of $ 1877 ha-1 with a benefit-cost ratio of 2.42 was reported in the treatment of cassava planted at the same time. Benefit-cost ratio was favourable for the pure cassava (3.2 to 3.8) but not favourable for the pure groundnut. Cassava intercropping with groundnut had significantly (P = 0.019) lower profits than the pure cassava. The results suggest that cassava should be planted at the same time or not later than 2 weeks after the groundnuts to maximize yields and economic returns in a cassava-groundnut intercrop.

A commentary on occupational infectious diseases due to agricultural practices in Sub-Saharan Africa

Occupational diseases associated with agricultural practices in Sub-Saharan Africa have a major health impact on farmers, farm workers and their families. This leads to reduced productivity through decreased human and livestock resource and places an additional burden on health care requirements in already poor areas. An in-depth knowledge of the various diseases and potential risks associated with farming in SSA could provide insights on effective control measures. This paper presents a review of infectious disease in farmers in Sub-Saharan Africa likely to have been contracted as a result of farming practices. The following are considered: Sources, modes of transmission, incidence, prevalence, morbidity and mortality. Infections have been classified into those of bacterial, parasitological, mycological and virological origin. The literature indicates that 80% of cases of occupational diseases due to farming with high morbidity and mortality are from helminths, protozoa and bacterial infections. More effective reporting of disease, risk awareness and appropriate intervention methods, are required to tackle the occurrence of occupational diseases amongst farmers in Sub-Saharan Africa.

P97 Management of type 2 diabetes in clinical practices in sub-Saharan Africa: Results of the AMAR-AFO study in Senegal and Ivory Cost

P97 Management of type 2 diabetes in clinical practices in sub-Saharan Africa: Results of the AMAR-AFO study in Senegal and Ivory Cost

Marital Concurrency and HIV Risk in 16 African Countries

Research has identified sexual concurrency as a potential underlying driver of high HIV infection levels in sub-Saharan Africa, though few studies have explicitly examined the contribution of marital concurrency. Utilizing a multi-level model of Demographic and Health Surveys with HIV-biomarkers for sixteen African countries, this study assessed the relationship between an individual's HIV serostatus and rates of formal and informal marital concurrency (% polygamous unions, % extramarital partner past year) among married men and women. Mutually exclusive regional-level variables were constructed and modeled to test the contextual risk posed by living in a region with higher levels of formal and informal marital concurrency controlling for individual sexual partnerships and other covariates. Compared with regions where monogamous unions were more prevalent, the odds of having HIV were higher among individuals living in regions with more informal marital concurrency, but lower in regions with more polygamy, even accounting for individual-level sexual behavior. These results can help inform prevention policy and practice in sub-Saharan Africa.

Heart Surgery Practice in Sub Saharan Africa: Single Nigerian Institutional Midterm Results and Challenges

Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.

Prevalence of and Factors Associated with Oral Sex Among Rural and Urban Malawian Men

ABSTRACT Objectives: Despite medical evidence that female-to-male oral sex (fellatio) carries a lower risk for HIV transmission than unprotected vaginal intercourse, little research exists on the practice of fellatio in Africa. The objective of this study was to document the prevalence of oral sex in Malawi, and to provide the first evidence on factors associated with the practice in sub-Saharan Africa. Methods: We used two samples of men from Malawi—one rural and one urban—to examine the prevalence of oral sex, as well as factors that were associated with the knowledge and practice of oral sex. Results: While 97% of the rural sample and 87% of the urban sample reported having had vaginal sex, just 2% and 12%, respectively, said they had ever received oral sex. Only half of the rural sample, and less than three quarters of the urban sample, reported having heard of oral sex. Education, exposure to newspapers and television, and condom use significantly predicted oral sex knowledge after controlling for other confounding factors, while exposure to radio did not. Conclusions: The large gap between sexual activity and oral sex prevalence suggests that fellatio should be taken into consideration as a potential component of an HIV prevention strategy, but further quantitative and qualitative research that includes women as well as men is needed to understand potential benefits and drawbacks.

Adoption Potential of Conservation Agriculture Practices in Sub-Saharan Africa: Results from Five Case Studies

Despite the reported benefits of conservation agriculture (CA), its wider up-scaling in Sub-Saharan Africa (SSA) has remained fairly limited. This paper shows how a newly developed qualitative expert assessment approach for CA adoption (QAToCA) was applied to determine its adoption potential in SSA. CA adoption potential is not a predictor of observed adoption rates. Instead, our aim was to systematically check relevant factors that may be influencing its adoption. QAToCA delivers an assessment of how suitable conditions "and thus the likelihood for CA adoption" are. Results show that the high CA adoption potentials exhibited by the Malawi and Zambia case relate mostly to positive institutional factors. On the other hand, the low adoption potential of the Zimbabwe case, in spite of observed higher estimates, is attributed mainly to unstable and less secured market conditions for CA. In the case of Southern Burkina Faso, the potential for CA adoption is determined to be high, and this assessment deviates from lower observed figures. This is attributed mainly to strong competition of CA and livestock for residues in this region. Lastly, the high adoption potential found in Northern Burkina Faso is explained mainly by the fact that farmers here have no alternative other than to adopt the locally adapted CA system-Zaï farming. Results of this assessment should help promoters of CA in the given regions to reflect on their activities and to eventually adjust or redesign them based on a more explicit understanding of where problems and opportunities are found.

Rurality as a choice: Towards ruralising rural areas in sub-Saharan African countries

Rural development practices in sub-Saharan Africa are still based on modernisation approaches. This has led to distortion in rural identity in most sub-Saharan communities. This article embeds this issue in the development discourse. It calls for developing rural areas rurally – rather than urbanely. The paper argues that improvements in rural conditions should aim to make rural lives and the environment sustainable, while preserving rural identities. Drawing from literature, it presents a conceptual framework for understanding rurality and shows how planning can serve as a tool for achieving rurality focused development. It provides six suggestions that could lead to integrating rurality-as-a-choice in development policies and practices. The suggested measures include the heritagisation of rural areas, introduction of rurality-focused vision in planning, and organisation of campaigns for the protection of rural heritages, among others. It contributes to emerging literatures on identifying problem-generating issues in rural development in sub-Saharan Africa.

English

The objective of this study was to create a model of nursing practice in Sub-Saharan Africa based on population needs, current practice and expectations of stakeholders. A three component study was done in eight sub-Saharan countries to ascertain (1) the health needs and the burden of disease in these countries, as well as evaluating the structure of their health systems; (2) the views on nursing functions held by opinion leaders in the community, other health professionals, patients and their families; and (3) to conduct a survey of nurses and midwives to determine the roles that they actually perform in hospitals and public health centres (PHCs). Four Anglophone and 4 Francophone countries were studied with a document audit, and 191 stakeholders included in focus groups. The current practice of 734 nurses in ambulatory and hospital settings was evaluated. Based on a triangulation of this data, 9 roles were identified:  the provision of holistic care, health education, managing the care environment, as well as the advocacy and collaboration, providing emergency care, providing midwifery care, prevention and management of infectious diseases and diagnosis and treatment. Three contextual support factors (positive policies and practices, an enacted regulatory framework and an enabling educational system) were also identified. Key words: Africa, midwives, nurses, roles.