Technical Working Group Research Articles

A suspect cluster of childhood cancer in Valle di Ledro (Province of Trento, Northern Italy). Epidemiological evaluation, risk management, and communication activities, 2018-2020

leukaemia is the most prevalent form of childhood cancer, an overall rare condition in childhood. Even few cases occurring in a small community can cause considerable apprehension among the population. From 2014 to 2017, 4 cases of childhood cancer occurred in Valle di Ledro, a municipality of 5,300 inhabitants in Province of Trento (Northern Italy), and a group of concerned citizens asked provincial health authorities for an investigation. to address the community's health needs by verifying the hypothesis of a cluster of childhood cancer and through effective risk communication activities. retrospective cohort analysis based on data from the Cancer registry of the Autonomous Province of Trento and data collected from hospital discharge records. The communication activities were carried out according to the recommendations published by Epidemiologia&Prevenzione in 2016 in a Supplement "Childhood cancers, risk factors and investigation models for the evaluation of spatio-temporal clusters". Valle di Ledro, a municipality of 5,300 inhabitants in the Province of Trento. The participants in risk communication process were: city council; grassroot committee of concerned parents; health workforce of different services (epidemiology, cancer registry, public health; environmental health; primary health care; personnel of the Environmental Protection Agency; journalists; general population. The participants in the statistical analyses were: children of 0-14 years of age who were diagnosed a cancer from 1998 to 2014 in the Province of Trento (N. 212); leukaemia (N. 84) and acute lymphoblastic leukaemia (N. 66) incident cases in the period 1998-2017 in Trento province. verification of the presence of a cluster of childhood cancers; degree of consensus and collaboration of the different community stakeholders to the survey procedures and acceptance of the final results; atmosphere in public assemblies and feedback in the local press. a total of 212 incident cancer cases in children 0-14 years have been registred in Province of Trento from 1998 to 2014, leukaemia in 35% (N. 74) cases. From 2015 to 2017, another 10 cases of leukaemia occurred, for a total of 84 cases of leukaemia from 1998 to 2017. In the years from 1998 to 2017, in Valle di Ledro, taking the Italian population as reference group, the standardized incidence ratios (SIRs) were the following: cancer, all types 1,47 (IC95% 0,40-3,76); leukaemia 3,39 (IC95% 0,70-9,90), LLA 2,81 (IC95% 0,34-10,16). No cluster emerged from the geographical analyses. From the very beginning of the risk management approach, a decision-making working group was set up applying a participatory approach. Group members included the city council and the local committee of concerned parents and experts from different services of the local health unit. Data analyses was delegated to a technical working group that reported back to the decision-making group. Members of the technical working group were supervised by external experts. Following this approach, it was possible to establish a climate of trust and credibility. The involvement of all stakeholders right from the start in a totally transparent process was a key element of success. the cluster hypothesis was rejected for both childhood cancer (all types) and leukaemia (all types and ALL). The implementation of the risk communication process recommended by the AIE guidelines was successful in establishing a climate of reciprocal trust that allowed to overcome inevitable moments of conflict in a productive manner. Thanks to this positive atmosphere, the communication of the results of the statistical analyses was effective in reassuring the population.

Ayoade Alakija: advancing equity in the COVID-19 response

Ayoade Alakija: advancing equity in the COVID-19 response

Impact of COVID-19 on Gender-Based Violence Prevention and Response Services in Kenya, Uganda, Nigeria, and South Africa: A Cross-Sectional Survey.

BackgroundEpidemics and other complex emergencies historically have had a disproportionate impact on women and girls, increasing their vulnerability to gender-based violence (GBV). The COVID-19 pandemic has been no different, with reports of rising cases of GBV emerging worldwide. Already a significant problem in Kenya, Uganda, Nigeria, and South Africa, GBV in these countries has been exacerbated by government restrictions intended to contain the spread of COVID-19. The purpose of this study was to understand how the COVID-19 pandemic affected the availability of GBV prevention and response services from the perspective of the organizations that provide them.MethodsA cross-sectional online survey of people who work in GBV prevention and response in Kenya, Uganda, Nigeria, and South Africa was administered from July to October 2020. A convenience sample was identified through web search, contacts of in-country consultants, and relevant listservs and technical working groups. Descriptive analyses were completed using SPSS.ResultsA total of 187 respondents completed the survey. Nearly all (98.9%) survey respondents reported that COVID-19 impacted their work. The majority (77.9%) stated that work decreased due to government restrictions or GBV services being deemed non-essential. The types of service most impacted were community-based prevention, shelters, and legal services. Survey respondents overwhelmingly agreed (99.3%) that COVID-19 impacted GBV prevalence and identified adolescents and women with disabilities as particularly vulnerable groups.ConclusionsGBV prevention and response services in Kenya, Uganda, Nigeria, and South Africa were highly impacted by the COVID-19 pandemic, largely due to government restrictions and the failure of governments to deem GBV services as essential. Preparedness for future crises should ensure that GBV is adequately prioritized in the initial response in order to maintain service availability with special attention paid to at-risk populations.

The Role of Nuclear Forensics for Determining the Origin of Nuclear Materials Out of Regulatory Control and Nuclear Security

The international community recognizes the rise in theft and illicit trafficking of nuclear materials and radioactive sources—for malicious use and nuclear terrorism—as a serious threat. That is why a well-developed nuclear forensics capability is an integral part of a robust nuclear security program and a key element of nuclear security infrastructure. Both pre- and post-detonation nuclear forensics are vital for controlling theft and illicit trafficking of nuclear materials, as well as identifying and tracing their sources. Nuclear forensics analysis and interpretation processes for nuclear security is a systematic process that includes: (1) sample collection and categorization techniques and (2) detailed nuclear forensics analytical plans, which are a laboratory analysis of physical and chemical properties of the collected or seized nuclear and radioactive materials. Besides nuclear materials, the non-nuclear and biological materials present in seized nuclear materials can also provide important information about the source and origin of nuclear materials. Upon complete analysis of the seized materials, the data interpretation to trace the origin of the nuclear and radiological materials is one of the most critical steps to identifying the origin of the materials, which depends on the availability of similar data to compare. So, each country should have its own incident register system (IRS) and collaborate with the International Technical Working Group (ITWG), Incident and Trafficking Database (ITDB), and IAEA for data sharing and interpretation.

Rapid establishment of a frontline field laboratory in response to an imported outbreak of Ebola virus disease in western Uganda, June 2019

The Democratic Republic of the Congo (DRC) declared an Ebola virus disease (EVD) outbreak in North Kivu in August 2018. By June 2019, the outbreak had spread to 26 health zones in northeastern DRC, causing >2,000 reported cases and >1,000 deaths. On June 10, 2019, three members of a Congolese family with EVD-like symptoms traveled to western Uganda’s Kasese District to seek medical care. Shortly thereafter, the Viral Hemorrhagic Fever Surveillance and Laboratory Program (VHF program) at the Uganda Virus Research Institute (UVRI) confirmed that all three patients had EVD. The Ugandan Ministry of Health declared an outbreak of EVD in Uganda’s Kasese District, notified the World Health Organization, and initiated a rapid response to contain the outbreak. As part of this response, UVRI and the United States Centers for Disease Control and Prevention, with the support of Uganda’s Public Health Emergency Operations Center, the Kasese District Health Team, the Superintendent of Bwera General Hospital, the United States Department of Defense’s Makerere University Walter Reed Project, and the United States Mission to Kampala’s Global Health Security Technical Working Group, jointly established an Ebola Field Laboratory in Kasese District at Bwera General Hospital, proximal to an Ebola Treatment Unit (ETU). The laboratory consisted of a rapid containment kit for viral inactivation of patient specimens and a GeneXpert Instrument for performing Xpert Ebola assays. Laboratory staff tested 76 specimens from alert and suspect cases of EVD; the majority were admitted to the ETU (89.3%) and reported recent travel to the DRC (58.9%). Although no EVD cases were detected by the field laboratory, it played an important role in patient management and epidemiological surveillance by providing diagnostic results in <3 hours. The integration of the field laboratory into Uganda’s National VHF Program also enabled patient specimens to be referred to Entebbe for confirmatory EBOV testing and testing for other hemorrhagic fever viruses that circulate in Uganda.

Overcoming blame culture: key strategies to catalyse maternal and perinatal death surveillance and response.

Maternal and perinatal death surveillance and response (MPDSR) is a health systems process entailing the continuous cycle of identification, notification, and review of maternal and perinatal deaths (Surveillance), followed by actions to improve service delivery and quality of care and Response. Prior to the COVID-19 pandemic, there were an estimated 4.6 million maternal and newborn deaths and stillbirths each year. During the pandemic, maternal and perinatal health outcomes have worsened, especially in low- and middle-income countries, highlighting the urgent need to galvanize MPDSR to end preventable mortality and strengthen health systems.

Experience in fostering regional collaboration and Coordination to use data for battling infectious diseases in sub-Saharan Africa.

The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywhere and rapidly spread globally. Lessons emphasise the necessity for strengthening regional and global collaboration and coordination to allow rapid risk identification, resource mobilisation and joint actions. We report the experience of the Regional Action through Data (RAD) partnership in fostering regional cooperation and collaboration to use data for battling infectious diseases and the effects of COVID-19. The Partnership comprised;BoadReach company, The West African Health Organization (WAHO) and the Intergovernmental Authority on Development (IGAD); Duke University Global Health Centre and the Jembi Health Systems, South Africa.Main objective:To address the problem of limited used of data to drive performance in healthcare service delivery in sub-Saharan Africa; by changing how and why data is collected, analysed, and then used to achieve results.Specific objectives:1. Regional level: To equip and empower IGAD and WAHO with evidence-based analytics to drive data use for evidence-based policy and program action in public health (regional level). 2. Patient-provider level: To deploy and implement a digital health solution for child-hood vaccination services focused on mobile cross-border populations along the Uganda-Kenya border.Engagement approaches used included; meetings, workshops, technical working groups, establishing monitoring system and annual implementation revision. Targeted training and capacity building were conducted. All activities were built on existing systems and structures to strengthen ownership and sustainability.Regional level achievements:1. Regional health data sharing and protection policy, 2. Strengthened regional health information platform. Patient provider level: Deployment of a cloud based digital health solution to enhance childhood access to vaccination services for cross border populations of Kenya and Uganda, 3. Both regions developed resource mobilisation plans for sustainability.RAD established the foundation for building trust and strengthening regional collaboration and coordination in health in Sub-Saharan Africa.

Morphological and chemical characterization of uranium and cerium nuclear forensics samples

• Uranium and cerium containing samples were examined as part of an international nuclear forensics exercise. • The main technique for characterization was the combined analysis by SEM-EDS/Raman of the surface. • Connection between the ingots was determined by uranium and cerium isotopic ratios as well as yttria and graphite surface contaminations. • Sample preparation history was interpreted based on surface contaminations, showing multiple impurities present in suggested production and processing sites. The objective of this paper is to describe nuclear forensics material characterization, as conducted in the Israeli National Nuclear Forensic Laboratory (INNFL) during an international exercise Collaborative Material Exercise 6 (CMX6) organized by the Nuclear Forensics international technical working group (ITWG). The characterized materials are uranium and cerium metal ingots. The goal was characterization of physical parameters, elemental and isotopic composition, morphology and chemical composition of the surface. Electron microscopy and Raman spectroscopy techniques were combined for morphological, structural and elemental study of the surface. The information from these analyses was used to answer the exercise questions, comparing the materials (labeled ES-1 and ES-2) to each other and to other samples described in the scenario. The INNFL investigation identified a connection between ES-1 and ES-2 based on several indicators, including the isotopic composition of the uranium present in both samples, as well as other surface contaminations, mainly yttria and graphite. Based on these finding the INNFL established a connection between ES-1 and ES-2 to ES-3B (theoretical sample with uranium traces) and has not established a connection to ES-3A (theoretical sample of plutonium powder). ES1 and ES-2 have been suggestively connected to their theoretical source, by their isotopic ratio. The INNFL conclusion was that the theoretical source materials (oxide and fluoride) were converted into the actual materials.

9.B. Workshop: Burden of disease of COVID-19: strengthening the collaboration for national studies

The spread of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was categorized as a pandemic by the World Health Organization in March 2020. Since the outbreak was first identified in December 2019 in Wuhan, China, the public health impact of the disease globally has been enormous. Estimating the burden of the disease at national level is useful for comparing its impact with other diseases in the population and across populations. The disability-adjusted life year (DALY) is one of the most used summary measure of population health, and the key metric in the Global Burden of Disease study. The European Burden of Disease Network (burden-eu) was established in 2019 to act as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. It is structured in technical and disease-focused working groups focus. Since the start of the pandemic, burden-eu has developed tools and started initiatives to support countries in estimating the national burden of COVID-19. These include developing and harmonizing methodologies, disseminating technical materials, launching a working group and online forum, exchanging experiences and supporting capacity building, and planning future studies. This workshop consists of four presentations. In the first, we present a consensus methodology, data requirements and solutions to data gaps to estimate national-level burden of COVID-1. Next, we present as examples results of studies conducted in Germany and Scotland, and the status of an international effort to harvest real-world data derived from the health systems' response across Europe and internationally during the pandemic. The fourth presentation describes burden-eu's activities to promote capacity building to estimate the burden of COVID-19, and discusses the importance, needs and lessons learned of sharing experience and of communicating COVID-19 data. The workshop will end with ample time for discussions on current approaches and opportunities for methodological developments, challenges, possible solutions and potential for collaborations to increase implementation and utility of studies of COVID-19 burden globally.Key messages National burden of disease studies offer a means of monitoring the direct population health impact of COVID-19 infection in countries.International initiatives have emerged to promote harmonization of methods, share knowledge and support international collaboration across countries and public health authorities worldwide.

Antimicrobial resistance national level dialogue and action in Ghana: setting and sustaining the agenda and outcomes

BackgroundAntimicrobial resistance (AMR) has gained national and international attention. The design and launch of national policy on antimicrobial use and resistance and action plan marked a milestone in Ghana’s commitment to control AMR. These strategies are some outcomes of getting and sustaining AMR issues prominence on government’s agenda. Understanding the agenda setting processes, policy actors involved and policy change is important as this provides insights on how and why policy actors defined and framed AMR issues to sustain its prominence despite the changing priorities of government agenda.ObjectiveTo examine the processes of setting and sustaining AMR issues on government agenda, the policy actors involved and resulting outcomes.MethodsA qualitative study was conducted and data collected through interviewing twenty-four respondents and reviewing technical working group meeting reports and health sector documents. Data was analysed drawing on Kingdon’s agenda setting framework.ResultMembers of a multisectoral technical working group (AMR platform) formed in 2011 constantly built consensus on AMR problem definition, solutions and actively engaged decision makers to mobilise support and interest. The AMR platform members sustained AMR attention and prominence on government’s agenda through the following multisectoral coordination mechanisms: (1) institutionalising AMR platform activities (2) gathering evidence, sharing findings, and supporting research (3) creating awareness and training (4) gaining and maintaining political support. The activities of the AMR platform contributed to three remarkable outcomes and these are (1) maintained network of AMR Champions, (2) design of a national policy on antimicrobial use and resistance in Ghana (1st edition) and national action plan (2017–2021), and (3) Ghana’s hosting of the second Global call to action on AMR.ConclusionThe AMR platform members as influencers concentrated their efforts to move and sustain AMR issues on government agenda. The identified multisectoral coordination mechanisms collectively contributed to agenda setting processes and policy change. The AMR platform engagements are ongoing and it is important the momentum is maintained. As multisectoral coordination and activities are vital especially for AMR ‘One Health’ approach, we hope this paper presents lessons for better understanding of how and why multisectoral groups influence national level agenda setting processes.

Technical guidelines for seasonal influenza vaccination in China (2021-2022)

Technical guidelines for seasonal influenza vaccination in China (2021-2022)

The Enhancing NeuroImaging Genetics through Meta-Analysis Consortium: 10 Years of Global Collaborations in Human Brain Mapping.

This Special Issue of Human Brain Mapping is dedicated to a 10‐year anniversary of the Enhancing NeuroImaging Genetics through Meta‐Analysis (ENIGMA) Consortium. It reports updates from a broad range of international neuroimaging projects that pool data from around the world to answer fundamental questions in neuroscience. Since ENIGMA was formed in December 2009, the initiative grew into a worldwide effort with over 2,000 participating scientists from 45 countries, and over 50 working groups leading large‐scale studies of human brain disorders. Over the last decade, many lessons were learned on how best to pool brain data from diverse sources. Working groups were created to develop methods to analyze worldwide data from anatomical and diffusion magnetic resonance imaging (MRI), resting state and task‐based functional MRI, electroencephalography (EEG), magnetoencephalography (MEG), and magnetic resonance spectroscopy (MRS). The quest to understand genetic effects on human brain development and disease also led to analyses of brain scans on an unprecedented scale. Genetic roadmaps of the human cortex were created by researchers worldwide who collaborated to perform statistically well‐powered analyses of common and rare genetic variants on brain measures and rates of brain development and aging. Here, we summarize the 31 papers in this Special Issue, covering: (a) technical approaches to harmonize analysis of different types of brain imaging data, (b) reviews of the last decade of work by several of ENIGMA's clinical and technical working groups, and (c) new empirical papers reporting large‐scale international brain mapping analyses in patients with substance use disorders, schizophrenia, bipolar disorders, major depression, posttraumatic stress disorder, obsessive compulsive disorder, epilepsy, and stroke.

45Nigeria Centre for Disease Control Resident Doctors Internship Pilot: Translating Knowledge To Action In Epidemiology

45Nigeria Centre for Disease Control Resident Doctors Internship Pilot: Translating Knowledge To Action In Epidemiology

Executive summary of the 2020 clinical practice guidelines for the management of hypertension in the Philippines.

Hypertension is the most common cause of death and disability worldwide with its prevalence rising in low to middle income countries. It remains to be an important cause of morbidity and mortality in the Philippines with poor BP control as one of the main causes. Different societies and groups worked and collaborated together to develop the 2020 Philippine Clinical Practice Guidelines of hypertension arising for the need to come up with a comprehensive local practice guideline for the diagnosis, treatment, and follow up of persons with hypertension. A technical working group was organized into six clusters that analyzed the 30 clinical questions commonly asked in practice, looking into the definition of hypertension, treatment thresholds, blood pressure targets, and appropriate medications to reach targets. This guideline also includes recommendations for the specific management of hypertension among individuals with uncomplicated hypertension, hypertension among those with diabetes, stroke, chronic kidney disease, as well as hypertension among pregnant women and pediatric populations. It also looked into the appropriate screening and monitoring of patients when managing hypertension, and identification of groups who are at high risk for cardiovascular (CV) events. The ADAPTE process was used in developing the statements and recommendations which were then presented to a panel of experts for discussion and approval to come up with the final statements. This guideline aims to aid Filipino healthcare professionals to provide evidence‐based care for persons with hypertension and help those with hypertension adequately control their blood pressure and reduce their CV risk

Experiences and Lessons Learnt from the HIV Treat All Pilot Phase Implementation in Zimbabwe.

Zimbabwe adopted the Treat All recommendations and started to implement them nationwide in 2017. Before launch, Treat All was piloted in nine districts. The sharing of implementation experiences and knowledge gained will significantly contribute to the implementation success in settings where Treat All still needs to be rolled out. We report on experiences and lessons learnt from the implementation of Treat All during the pilot phase in Zimbabwe. Coordination and well-structured engagement plans with the districts led to the successful implementation of the Treat All pilot. The established technical working groups offered standardisation and a platform for the exchange of experience between the implementing partners and the Ministry of Health and Child Care. Training and capacity building of the healthcare workers through mentoring, support and supervision, and the provision of job aides were necessary to equip them with the required skills. Community knowledge, commitment and support were critical to the successful implementation of the guidelines. Health facilities preparedness was of great importance. This enabled the health facilities to develop mitigating strategies at the local level using existing resources. Studies examining how patient outcomes will progress under Treat All are pertinent.

Target product profile for a dengue pre-vaccination screening test.

With increasing geographic spread, frequency, and magnitude of outbreaks, dengue continues to pose a major public health threat worldwide. Dengvaxia, a dengue live-attenuated tetravalent vaccine, was licensed in 2015, but post hoc analyses of long-term data showed serostatus-dependent vaccine performance with an excess risk of hospitalized and severe dengue in seronegative vaccine recipients. The World Health Organization (WHO) recommended that only persons with evidence of past dengue infection should receive the vaccine. A test for pre-vaccination screening for dengue serostatus is needed. To develop the target product profile (TPP) for a dengue pre-vaccination screening test, face-to-face consultative meetings were organized with follow-up regional consultations. A technical working group was formed to develop consensus on a reference test against which candidate pre-vaccination screening tests could be compared. The group also reviewed current diagnostic landscape and the need to accelerate the evaluation, regulatory approval, and policy development of tests that can identify seropositive individuals and maximize public health impact of vaccination while avoiding the risk of hospitalization in dengue-naive individuals. Pre-vaccination screening strategies will benefit from rapid diagnostic tests (RDTs) that are affordable, sensitive, and specific and can be used at the point of care (POC). The TPP described the minimum and ideal characteristics of a dengue pre-vaccination screening RDT with an emphasis on high specificity. The group also made suggestions for accelerating access to these RDTs through streamlining regulatory approval and policy development. Risk and benefit based on what can be achieved with RDTs meeting minimal and optimal characteristics in the TPP across a range of seroprevalences were defined. The final choice of RDTs in each country will depend on the performance of the RDT, dengue seroprevalence in the target population, tolerance of risk, and cost-effectiveness.

Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe cervical Cancer prevention and control strategy (2016\u20132020)

BackgroundCervical cancer is the fourth most common cancer amongst women globally and it accounts for the majority of cancer deaths among females in Zimbabwe. The objective of this midterm review analysis was to identify the gaps and opportunities for cervical cancer prevention, diagnosis, treatment, and care to inform the next cervical cancer strategy in Zimbabwe.MethodsA mixed methods approach was used for the midterm review. Secondary data was collected from programme documents, published and grey literature. Primary data was collected in six provinces through key informant interviews with officials and focus group discussions with beneficiaries. After data analysis, a draft report was presented to a technical working group to validate the findings and to fill in any gaps.ResultsThis midterm review revealed a myriad of gaps of the strategy particularly in diagnosis, treatment and care of cervical cancer and the primary focus was on secondary prevention. There was no data to quantify the level of awareness and advocacy for cervical cancer prevention. Our results revealed that there was no data on the proportion of women who ever tested for cervical cancer which existed nationally. Our findings suggest that some health facilities were screening women above 50 years old using VIAC, which is an inappropriate approach for those women. Quality control of VIAC and treatment of precancers were not part of the strategy. Pathological services were not efficient and effective due to lack of resources and additionally data on investigations were not routinely collected and available at the national level. Other gaps identified were limited funding, human resources, equipment, and commodities as well as lack of leadership at the national level to coordinate the various components of the cervical cancer programme. There are also numerous opportunities identified to build upon some successes realized to date.ConclusionsOur findings emphasized the importance of effective and holistic planning in cervical cancer screening programmes in low-resource settings. In addition, huge investments are required in cervical cancer programmes and governments need to take centre role in mobilizing the requisite resources.

Abstract 38: Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya.

Abstract Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-Saharan Africa including Kenya. Despite having a cancer diagnosis, patients and their families not living in major towns and cities, have to travel far to seek treatment incurring cost in transport, upkeep during treatment and out of pocket expenditure to access care. Methods: International Cancer Institute in Eldoret-Kenya, partnered with Taita Taveta County to implement a cancer and other non-communicable disease (NCD) project in August 2020. Taita Taveta County established a technical working group (TWG) in September 2020 to oversee the project activities and identified space and staff to set up a new cancer clinic. ICI provided technical support in project planning, budgeting, capacity/needs assessment, training and mentorship of healthcare providers; and running joint cancer clinics. Results: Periodic review meetings between ICI and Taita Taveta County TWG identified lack of: qualified staff to provide cancer care; cancer screening supplies; and drug stock-outs. In September 2020, ICI and its strategic partners supported Taita Taveta County to launch a Cancer Clinic to provide basic Cancer care. ICI offered trainings and continuous medical education on cancer for 91 healthcare providers both online (26) and on-site (65); ICI provided cervical, breast and prostate cancer screening supplies; established a revolving fund pharmacy as a stop gap measure to drug stock-outs; and held joint cancer clinics twice a month where mentorship and skills training for county staff paired with ICI staff across various disciplines was achieved resulting in the first patient receiving chemotherapy in November 2020; histopathology support was provided for 151 samples. Conclusion: The process of setting up a cancer clinic in a low resource setting requires a systematic needs assessment approach; identifying a core team early that outlines output measures of interest; and having strategic partnership guiding step-by-step developments. Citation Format: Gloria Kitur, Emmah Achieng, Rebecca Mwakichako, Felix Kimotho, Chite Asirwa. Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya. [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 38.

Assessment of Progress in Capacity Building of HIV/AIDS Supply Chain Workforce in Nigeria

This Study On Assessment Of Progress In Capacity Building Of HIV/AIDS Supply Chain Workforce In Nigeria Included Research Objectives, Questions, And Hypothesis. A Pre-Tested Self-Completion Structured Questionnaire Was Administered To Participants (422) With A Response Rate Of 396 (93.8%). The Reliability Statistics Showed The Questionnaire Is Less Reliable (Α = 0.237). Notable Progress Includes Donor Agencies Interventions Contributing Considerably To Capacity Building Of Government Personnel And Adequate Capacity At The National Level 396 (100.0), The Institutionalization Of Capacity Development At All Levels Through National Product Supply Chain Management Programme, Procurement And Supply Management Technical Working Groups, And Logistics Management Coordinating Unit 292 (73.7) And Demonstrable Capacity In Key Supply Chain Functions 259 (65.4). The Study Revealed Substantial Progress In Capacity Building Of The HIV/AIDS Supply Chain Workforce, Evident With The Institutionalization Of Capacity Building And Demonstrable Capacity In The Key Supply Chain Functions. More So, Master Trainers From The Government Are Not Always Part Of The Facilitators And Involved In Capacity Building, Needs Assessment Does Not Always Precede Capacity Building, The Inadequate Pool Of Master Trainers, Fellowship Training Program Is Not Recognized, And Pre-Service Training Has Not Been Institutionalized. Chi-Square Statistics Revealed That The Extent Of Progress In Capacity Building Is A Significant Factor Of HIV/AIDS Supply Chain Workforce Capacity (P&lt;0.05). There Is A Need To Develop Manuals, Policies, And Procedures To Ensure Sustained Progress In Capacity Building, Needs Assessment Precedes Capacity Building, More Training Conducted To Ensure An Adequate Pool Of Master Trainers In The Public Sector And Their Participation In Future Capacity Building Interventions.

The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox's Bazar, Bangladesh.

On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh’s district of Cox’s Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.