Settings In sub-Saharan Africa Research Articles

Challenges for hepatitis B virus cure in resource-limited settings in sub-Saharan Africa.

The aim of this article is to highlight the unique challenges for hepatitis B virus (HBV) cure faced in resource-limited settings (RLS) in sub-Saharan Africa (SSA), where access to disease prevention measures, medical testing, and treatment are limited. SSA RLS face challenges, which need to be anticipated as HBV cure research advances. There is a paucity of data because of lack of HBV surveillance and limited access to laboratories. Interruption of transfusion-transmitted infections, perinatal mother-to-child-transmissions, and transmission in people-who-infect-drug networks has not been achieved fully. Although RLS in SSA are within the epicenter of the HIV pandemic, unlike for HIV, there is no population-based testing for HBV. Public health response to HBV is inadequate with concomitant political inertia in combatting HBV infection. A functional HBV cure will improve the diagnosis/treatment cascade, decrease costs and accelerate HBV elimination. There is a concerted effort to find a HBV cure, which will be finite, not require life-long treatment, adherence, and continued monitoring. Increased research, improved financial, infrastructural and human resources will positively impact on implementation of HBV cure, when available. We can emulate major strides made in tackling HIV and the strength of advocacy groups in soliciting policymakers to take action.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.

Beyond Their HIV Status: the Occurrence of Multiple Health Risk Behavior Among Adolescents from a Rural Setting of Sub-Saharan Africa

BackgroundHealth risk behaviors during adolescence may cluster into patterns that might be predicted by specific factors, among which HIV may have an important role.MethodIn a cross-sectional study conducted between 2017 and 2018, clustering of HRB and its associated factors was investigated in rural Kenya among 588 adolescents (36% perinatally HIV infected; 28% perinatally HIV exposed but uninfected; and 36% HIV unexposed/uninfected). Latent class analysis of 22 behaviors followed by multinomial logistic regression were conducted. Four risk behavior classes were identified.ResultsNo significant differences were found in behavioral class membership across the three HIV groups (p = 0.366). The risk of membership to the higher risk behavioral classes relative to class 1 (the substance and drug abstinent low risk takers) increased with older adolescent age (p = 0.047), increased among adolescent who experienced mental distress (p < 0.001), and those who felt unsafe in their neighborhood (p < 0.002). Better working memory (p = 0.0037) was found to be protective.ConclusionThe results highlight a need to include screening and interventions for internalizing mental health problems and deficits in executive functioning, as well as steps to involve family members and communities to address psychosocial risk factors in adolescents in Kenya.

Diffusion and spillover effects of an evidence-based mental health intervention among peers and caregivers of high risk youth in Sierra Leone: study protocol

BackgroundEvidence-based mental health interventions have helped address health services gaps, but their reach and societal benefit can be limited in low resource settings. The current study extends an ongoing scale-up study of a cognitive behavioral therapy (CBT)-based intervention, the Youth Readiness Intervention (YRI), among high risk youth in post-conflict Sierra Leone to investigate mechanisms of diffusion and spillover effects of the YRI among peers and caregivers of youth who receive the intervention.MethodsWe will recruit and enroll YRI index participants and control index participants (ages 18–30). Index participants will complete a standardized ego-network survey to nominate three peers in their social networks and identify their primary cohabitating caregiver. Identified peers and caregivers who consent to participate will complete a quantitative assessment battery on mental health outcomes, emotion regulation, and daily functioning at baseline and 8-month follow-up. Study outcomes also incorporate common indicators for implementation science, including measures of project context, evaluation, and scaleup. Social network analysis will investigate diffusion of YRI components across peer networks. Linear growth modeling will examine mental health spillover effects among caregivers. Incremental health costs and benefits among YRI participants’ caregivers and peers will be assessed through cost-effectiveness and return on investment analysis.DiscussionAssessing implementation research outcomes, including penetration of YRI effects across social networks and cost-effectiveness of the YRI as distinct outcomes, will provide key information about the success of YRI implementation. Lessons learned could inform decisions to increase scale up efforts in Sub-Saharan Africa and other low resource settings.

Determining virological suppression and resuppression by point-of-care viral load testing in a HIV care setting in sub-Saharan Africa

BackgroundThis prospective pilot study explored same-day point-of-care viral load testing in a setting in Ghana that has yet to implement virological monitoring of antiretroviral therapy (ART). MethodsConsecutive patients accessing outpatient care while on ART underwent HIV-1 RNA quantification by Xpert. Those with viraemia at the first measurement (T0) received immediate adherence counselling and were reassessed 8 weeks later (T1). Predictors of virological status were determined by logistic regression analysis. Drug resistance-associated mutations (RAMs) were detected by Sanger sequencing. FindingsAt T0, participants had received treatment for a median of 8·9 years; 297/333 (89·2%) were on NNRTI-based ART. The viral load was ≥40 copies/mL in 164/333 (49·2%) patients and ≥1000 copies/mL in 71/333 (21·3%). In the latter group, 50/65 (76·9%) and 55/65 (84·6%) harboured NRTI and NNRTI RAMs, respectively, and 27/65 (41·5%) had ≥1 tenofovir RAM. Among 150/164 (91·5%) viraemic patients that reattended at T1, 32/150 (21·3%) showed resuppression <40 copies/mL, comprising 1/65 (1·5%) subjects with T0 viral load ≥1000 copies/mL and 31/85 (36·5%) subjects with lower levels. A T0 viral load ≥1000 copies/mL and detection of RAMs predicted ongoing T1 viraemia independently of self-reported adherence levels. Among participants with T0 viral load ≥1000 copies/mL, 23/65 (35·4%) showed resuppression <1000 copies/mL; the response was more likely among those with higher adherence levels and no RAMs. InterpretationSame-day point-of-care viral load testing was feasible and revealed poor virological control and suboptimal resuppression rates despite adherence counselling. Controlled studies should determine optimal triaging modalities for same-day versus deferred viral load testing. FundingUniversity of Liverpool, South Tees Infectious Diseases Research Fund

Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource-Limited Setting in Sub-Saharan Africa

Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource-Limited Setting in Sub-Saharan Africa

Epidemiological Profile of Male Infertility in Two Hospitals of Douala: A Cross-Sectional Study in a Sub-Saharan Africa Setting

<i>Background</i>: Male infertility is defined as a lack of pregnancy for a couple after 12 months of regular and normal sexual intercourse without contraception with the cause being clearly from the male origin. Contrary to popular belief, the prevalence of male infertility is similar to that of female infertility and sometimes even higher. However, data on the subject in Cameron are scarce and nonexistent in the city of Douala. This motivated the realization of this study in two centers in the city of Douala. The objective was to describe the epidemiological profile of male infertility. <i>Methods</i>: We conducted a cross-sectional study among patients who consulted for infertility in two hospital centers in Douala from January 2014 to October 2019. A consecutive sample of all eligible cases was considered for this study. Data were analyzed using Statistical Package for Social Sciences (SPSS Inc, Chicago, Illinois, USA) V. 20.0 and EPI-INFO V. 3.5 software. Analyzed variables included sociodemographic data (age, marital status, educational level, profession, region, alcohol, smoking habit and mean infertility duration) and other causes of infertility (obesity, history of testes infection, STI, testes traumatism, varicocele or varicocele surgery, herniorrhaphy, genetic or malformative disease). <i>Results</i>: We included 137 patients' records. The frequency of male infertility for patients consulting in urology was 5.6%. Their average age was 35.4±7.4 years. The average number of sexual intercourses per week was 2.7±0.97. Those patients were mainly from an intellectual profession (40.2%), married (71.5%) with a higher education level (67.2%). Almost 60% of the studied population had alcohol consumption. Primary infertility accounted for 65.7% of the study population and the average duration of infertility was 5.9±5.3 years. The main factors for infertility were respectively history of sexually transmitted infections (STI) in 59 (43.1%) and childhood mumps in 42 (32.7%) cases. Furthermore, herniorrhaphy (16.1%) and varicocelectomy (10.9%) were the most representative surgical background. <i>Conclusion</i>: Male infertility is not uncommon in urological consultation with primary infertility been more frequent. Risk factors of infertility in our setting included a history of STI, mumps, and surgery.

Early Effects of Antiretroviral Therapy on Vitamin D Status and Some Nutritional Markers of HIV-1 Infected Patients: A Case Control Study in a Sub-Saharan Africa Setting

Early Effects of Antiretroviral Therapy on Vitamin D Status and Some Nutritional Markers of HIV-1 Infected Patients: A Case Control Study in a Sub-Saharan Africa Setting

Oxytocin Versus Misoprostol Plus Oxytocin in the Prevention of Postpartum Hemorrhage at a Semi-Urban Hospital in sub-Saharan Africa: A Retrospective Cohort Study.

Background:Post-partum hemorrhage (PPH) is a leading cause of maternal mortality. Its first-line of prevention often entails uterotonic drugs like oxytocin and misoprostol which constitute a core point of management in low-resource settings of sub-Saharan Africa. This study aimed to assess the effectiveness of oxytocin alone compared with oxytocin plus misoprostol in two different eras (before and after the advert of misoprostol) of a semi-urban Cameroonian hospital.Methods:This was a retrospective cohort study carried out between January 2015 to April 2015 and between January 2016 to April 2016 on a group of parturients (group A) who received only oxytocin and another administered oxytocin and misoprostol (group B), respectively. All participants delivered at the Bamenda Regional Hospital, Cameroon. The two different periods represent the era before and after the implementation of misoprostol in the prevention of PPH in this semi-urban hospital. Socio-demographic data, clinical characteristics and details of delivery as well as risk factors for PPH were studied from obstetric records.Results:We studied the obstetric records of 1778 parturients were studied; 857 in group A and 879 in group B. Their mean age was 26.3 ±5.2 years. Both groups were comparable in several baseline sociodemographic and clinical characteristics. The prevalence of PPH was 2.7% (3.4% vs 2.2%; p = 0.0744). The risk of PPH in the oxytocin only group was about 1.5 times higher than in the oxytocin plus misoprostol group. The estimated blood loss between the two groups was statistically significant (1100 ± 150 vs 800 ± 100 ml, p< 0.0001). The active management of the third stage of labor without misoprostol was the only risk factor for PPH.Conclusion and Global Health Implications:The implementation of misoprostol plus oxytocin in the prevention of PPH in this low-resource setting improved the obstetrical outcome by reducing the risk and the amount of blood loss during delivery.

Multidetector computed tomography utilization in an urban sub-Saharan Africa setting: user characteristics, indications and appropriateness.

Introductionmultidetector computed tomography (MDCT) is a widely used cross-sectional imaging modality despite increasing concerns about radiation exposure and overuse. The aim of this study was to describe the socio-demographic characteristics of MDCT users in an urban city in Cameroon and to assess the clinical indications for appropriateness.Methodswe conducted a survey of MDCT users and collected data on demographic attributes and socialization patterns, clinical indications for MDCT and time to obtain MDCT. MDCT appropriateness was assessed using the American College of Radiologists Appropriateness Criteria®. Frequencies, percentages, odds ratios and 95% confidence intervals were used to summarize the data.Resultswith a response rate of 79%, 511 MDCT users were surveyed. The mean (standard deviation) age was 45(19) years and male to female sex ratio 1:1. Seventy-eight percent (95% confidence interval [CI]: 74-83%) of respondents reported not having any health insurance. Head scans accounted for 52% (95%CI: 47-56%) of all scans with trauma (19% [95%CI: 15-22%]), low back pain (18% [95%CI: 14-21%]) and suspected stroke (10% [95%CI: 7-13%]) being the most frequent indications. Sixteen percent (95%CI: 13-20%) of the scans were judged to be inappropriate. Predictors of MDCT appropriateness after multivariable logistic regression modeling were age (aOR=0.97; P=0.009; 95%CI=0.94-0.99), health insurance ownership (aOR=0.40; P=0.034; 95%CI=0.18-0.94) and being referred by non-specialist physicians (aOR=0.20; P<0.001; 95%CI=0.09-0.47).Conclusionpeople from all social strata use MDCT, mostly appropriately and especially for head scans after trauma in this urban setting. However, the proportion of inappropriate studies was considerable suggesting the need for control measures.

The World Health Organization 2030 goals for Taenia solium: Insights and perspectives from transmission dynamics modelling: CystiTeam Group for Epidemiology and Modelling of Taenia solium Taeniasis/Cysticercosis.

Taenia solium (TS), responsible for porcine cysticercosis, human taeniasis and (neuro)cysticercosis, was included in the World Health Organization neglected tropical disease (NTD) roadmap published in 2012. Targets set in this roadmap have not been met, but T. solium has been included in the consultation process for the new 2030 goals proposed for priority NTDs. Taenia solium transmission dynamics models can contribute to this process. A recent review has compared existing T. solium transmission models, identifying their similarities and differences in structure, parameterization and modelled intervention approaches. While a formal model comparison to investigate the impact of interventions is yet to be conducted, the models agree on the importance of coverage for intervention effectiveness and on the fact that human- and pig-focused interventions can be optimally combined. One of these models, cystiSim, an individual-based, stochastic model has been used to assess field-applicable interventions, some currently under evaluation in on-going trials in Zambia. The EPICYST, population-based, deterministic model has highlighted, based on simulating a generic sub-Saharan Africa setting, the higher efficacy (measured as the percentage of human cysticercosis cases prevented) of biomedical interventions (human and pig treatment and pig vaccination) compared to improved husbandry, sanitation, and meat inspection. Important questions remain regarding which strategies and combinations thereof provide sustainable solutions for severely resource-constrained endemic settings. Defining realistic timeframes to achieve feasible targets, and establishing suitable measures of effectiveness for these targets that can be quantified with current monitoring and evaluation tools, are current major barriers to identifying validated strategies. Taenia solium transmission models can support setting achievable 2030 goals; however, the refinement of these models is first required. Incorporating socio-economic elements, improved understanding of underlying biological processes, and consideration of spatial dynamics are key knowledge gaps that need addressing to support model development.

Solar-powered oxygen delivery for the treatment of children with hypoxemia: protocol for a cluster-randomized stepped-wedge controlled trial in Uganda

BackgroundChild mortality due to pneumonia is a major global health problem and is associated with hypoxemia. Access to safe and continuous oxygen therapy can reduce mortality; however, low-income countries may lack the necessary resources for oxygen delivery. We have previously demonstrated proof-of-concept that solar-powered oxygen (SPO2) delivery can reliably provide medical oxygen remote settings with minimal access to electricity. This study aims to demonstrate the efficacy of SPO2 in children hospitalized with acute hypoxemic respiratory illness across Uganda.MethodsObjectives: Demonstrate efficacy of SPO2 in children hospitalized with acute hypoxemic respiratory illness. Study design: Multi-center, stepped-wedge cluster-randomized trial. Setting: Twenty health facilities across Uganda, a low-income, high-burden country for pediatric pneumonia. Site selection: Facilities with pediatric inpatient services lacking consistent O2 supply on pediatric wards. Participants: Children aged < 5 years hospitalized with hypoxemia (saturation < 92%) warranting hospital admission based on clinical judgement. Randomization methods: Random installation order generated a priori with allocation concealment. Study procedure: Patients receive standard of care within pediatric wards with or without SPO2 system installed. Outcome measures: Primary: 48-h mortality. Secondary: safety, efficacy, SPO2 system functionality, operating costs, nursing knowledge, skills, and retention for oxygen administration. Statistical analysis of primary outcome: Linear mixed effects logistic regression model with 48-h mortality (dependent variable) as a function of SPO2 treatment (before versus after installation), while adjusting for confounding effects of calendar time (fixed effect) and site (random effect). Sample size: 2400 patients across 20 health facilities, predicted to provide 80% power to detect a 35% reduction in mortality after introduction of SPO2, based on a computer simulation of > 5000 trials.DiscussionOverall, our study aims to demonstrate mortality benefit of SPO2 relative to standard (unreliable) oxygen delivery. The innovative trial design (stepped-wedge, cluster-randomized) is supported by a computer simulation. Capacity building for nursing care and oxygen therapy is a non-scientific objective of the study. If successful, SPO2 could be scaled across a variety of resource-constrained remote or rural settings in sub-Saharan Africa and beyond.Trial registrationClinicaltrials.gov, NCT03851783. Registered on 22 February 2019.

A comparative analysis of the diagnostic performances of four clinical probability models for acute pulmonary embolism in a sub-Saharan African population: a cross-sectional study

BackgroundThe diagnosis of acute pulmonary embolism (PE) is one of the most challenging in emergency settings where prompt and accurate decisions need to be taken for life-saving purposes. Here, the assessment of the clinical probability of PE is a paramount step in its diagnosis. Although clinical probability models (CPM) for PE are routinely used in emergency departments (EDs) of low-resource settings, few studies have cited their diagnostic performances in sub-Saharan Africa (SSA). We aimed to comparatively assess the accuracy of four CPM in the diagnosis of acute PE in sub-Saharan Africans.MethodsWe carried out a cross-sectional study to compare the sensitivity, specificity, positive and negative predictive values and accuracy of four CPM namely; the Wells, simplified Wells, revised Geneva and the simplified revised Geneva (SRG) Scores to computed tomography pulmonary angiography (CTPA) in all adults patients with suspected PE admitted to the EDs of the Gynaeco-obstetric and Paediatric Hospital of Yaoundé and the Yaoundé Central Hospital in Cameroon between January 1, 2017 and April 30, 2018.ResultsIn total, we enrolled 30 patients with clinical suspicion of acute PE. PE was confirmed on CTPA in 16 (53.3%) cases. Their mean age was 53.7 ± 15.5 years and 36.7% were males. All four scores had a diagnostic performance superior to 50% in all criteria assessed. The simplified Wells score had the highest sensitivity (62.5%) followed by the Wells score (56.3%). The SRG score had the highest specificity (71.4%). The score with highest PPV was the SRG score (66.7%) and that with the highest NPV was the Wells score (56.3%). Overall the models with the highest accuracies were the Wells and SRG scores (60% for each).ConclusionAll CPM had a suboptimal diagnostic performance, perhaps highlighting the need of a more optimal CPM for acute PE in SSA. However, the Wells and the SRG scores appeared to be most accurate than the other two scores in the ED. Hence, both or either of them may be used in first intention to predict PE and guide which ED patients should undergo further investigations in an emergency SSA setting.

Gender differences in nutritional status, diet and physical activity among adolescents in eight countries in sub-Saharan Africa.

The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub-Saharan Africa. This study utilised cross-sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n=7625). Body mass index (BMI) was calculated using measured heights and weights, and z-scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face-to-face interviews using a standardised questionnaire. Site-specific and pooled prevalence ratios were determined. The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively). Our results emphasise that sex is a key predictor of nutritional status among sub-Saharan African adolescents and suggest that gender-specific interventions may be required to reduce the double burden of under- and overnutrition.

Are out-of-school adolescents at higher risk of adverse health outcomes? Evidence from 9 diverse settings in sub-Saharan Africa.

We analysed mutually comparable surveys on adolescent attitudes and behaviours from nine sites in seven sub-Saharan African countries, to determine the relationship between school enrolment and adolescent health outcomes. Data from the Africa Research, Implementation Science, and Education Network cross-sectional adolescent health surveys were used to examine the associations of current school enrolment, self-reported general health and four major adolescent health domains: (i) sexual and reproductive health; (ii) nutrition and non-communicable diseases; (iii) mental health, violence and injury; and (iv) healthcare utilisation. We used multivariable Poisson regression models to calculate relative risk ratios with 95% confidence intervals (CI), controlling for demographic and socio-economic characteristics. We assessed heterogeneity by gender and study site. Across 7829 adolescents aged 10-19, 70.5% were in school at the time of interview. In-school adolescents were 14.3% more likely (95% CI: 6-22) to report that their life is going well; 51.2% less likely (95% CI: 45-67) to report ever having had sexual intercourse; 32.6% more likely (95% CI: 9-61) to report unmet need for health care; and 30.1% less likely (95% CI: 15-43) to report having visited a traditional healer. School enrolment was not significantly associated with malnutrition, low mood, violence or injury. Substantial heterogeneity was identified between genders for sexual and reproductive health, and in-school adolescents were particularly less likely to report adverse health outcomes in settings with high average school enrolment. School enrolment is strongly associated with sexual and reproductive health and healthcare utilisation outcomes across nine sites in sub-Saharan Africa. Keeping adolescents in school may improve key health outcomes, something that can be explored through future longitudinal, mixed-methods, and (quasi-)experimental studies.

Do different patient populations need different early warning scores? The performance of nine different early warning scores used on acutely ill patients admitted to a low-resource hospital in sub-Saharan Africa

Early warning scores (EWS) generated in a developed healthcare setting may not perform as well in low-resource settings in sub-Saharan Africa. The performance of EWS used in developed world was compared with those generated in low-resource settings in sub-Saharan Africa. When tested on 1,266 acutely ill patients consecutively admitted to a low-resource Ugandan hospital there was no statistical difference in the performance of any of the EWS tested. The performance of all the scores appeared to be improved by the addition of mobility assessment. Although statistically insignificant, the National Early Warning Score with extra points added for impaired mobility had the highest discrimination and sensitivity. There were only marginal and no statistical differences in the performance of EWS generated in low- and high-resource healthcare settings in a cohort of unselected acutely ill medical patients admitted to a low-resource hospital in sub-Saharan Africa.