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Background. Epilepsy is a debilitating chronic medical condition affecting many patients globally. A seizure diary is used in monitoring and managing patients with epilepsy. In South Africa, no standardized diary is currently being used. Objective. This study intended to develop a consensus among experts managing patients with epilepsy on the content of a seizure diary. Methods. The modified Delphi method consisted of three survey rounds spanning six months. Using a three-point Likert scale questionnaire, in round one, the panelists were required to choose an option (definitely required, optional, and not required) for 50 items and comment on the contents of the diary. In round two, three items were added based on comments from the panelists. In round three, panelists were allowed to deliberate further on unresolved items and change their responses in view of the group responses. The consensus was determined as an a priori threshold of 70% on items definitely required, optional, or not required. Results. Eleven local and two international panelists were enrolled in this study. Twelve completed all three rounds. The consensus was achieved in 21 of 50 items in round 1, three of seven items in round 2, and one of two items in round 3, of which 18 were definitely required as contents of a seizure diary. Conclusions. Based on expert opinions, the modified Delphi study determined the essential contents of a seizure diary for use by patients with epilepsy in South Africa.

Van Howe and Storm’s paper is commended for asking valid questions regarding the scientific evidence upon which circumcision as an HIV prevention strategy is based. The paper however gives no real practical suggestions as to what the way forward should be regarding the already rolled out circumcision programs in Africa. This contribution seeks to highlight the importance of rigorous program evaluation as a critical practical implication of the paper and a way forward for such programs.

Background: The World Health Organisation (WHO) Regional Office for Africa (AFRO) has developed a comprehensive capacity development programme to support the successful implementation of the Integrated Disease Surveillance and Response 3rd edition Technical Guidelines (IDSR). As part of the learning program, a series of asynchronous online courses are offered on OpenWHO in English, French and Portuguese. This paper describes the use of five IDSR online courses and reports on feedback received from learners on Course 1 in the English series. Methods: An online learner survey was developed, and a descriptive analysis was conducted. This paper also reports on use related empirical metadata from the OpenWHO platform. Results: Overall, learners (97%-n/N) of Course 1 IDSR English series indicated a positive perception toward their online learning experience because of the quality of course content, its organization, ease of use and relevance to their workplace needs. In addition, 88% (n/N) of learners reported that they had used their acquired knowledge at least sometimes and 54.4% (n/N) had shared their learning with others. Lastly, the quiz analyses showed an average of right answers of 78.97% for quiz 1 and 69.94% for quiz 2. Conclusion: Online learning is an essential component of a blended capacity development programme and provides cost effective, equitable and impactful learning. Learners who have a learning goal and find their needs met in courses tend to show more satisfaction and motivation to share their learning.

Over the years, Ghana has made notable strides in adopting digital approaches to address societal challenges and meet demands. While the health sector, particularly the disease surveillance structure, has embraced digitization to enhance case detection, reporting, analysis, and information dissemination, critical aspects remain to be addressed. Although the Integrated Disease Surveillance and Response (IDSR) structure has experienced remarkable growth in digitization, certain areas require further attention as was observed during the COVID-19 pandemic. Ghana during the COVID-19 pandemic, recognized the importance of leveraging digital technologies to bolster the public health response. To this end, Ghana implemented various digital surveillance tools to combat the pandemic. These included the ‘Surveillance Outbreak Response Management and Analysis System (SORMAS)’, the digitalized health declaration form, ArcGIS Survey123, Talkwalker, ‘Lightwave Health information Management System’ (LHIMS), and the ‘District Health Information Management System (DHIMS)’. These digital systems significantly contributed to the country's success in responding to the COVID-19 pandemic. One key area where digital systems have proved invaluable is in the timely production of daily COVID-19 situational updates. This task would have been arduous and delayed if reliant solely on paper-based forms, which hinder efficient reporting to other levels within the health system. By adopting these digital systems, Ghana has been able to overcome such challenges and provide up-to-date information for making informed public health decisions. This paper attempts to provide an extensive description of the digital systems currently employed to enhance Ghana's paper-based disease surveillance system in the context of its response to COVID-19. The article explores the strengths and challenges or limitations associated with these digital systems for responding to outbreaks, offering valuable lessons that can be learned from their implementation.

The pandemic of coronavirus disease 2019 (COVID-19), for which there does not appear to be an approved cure, the primary treatment options consist of non-pharmacological preventive measures and supportive treatment that are aimed at halting the progression of the disease. Nuclear factor kappa B (NFkB) presents a promising therapeutic opportunity to mitigate COVID-19-induced cytokine storm and reduce the risk of severe morbidity and mortality resulting from the disease. However, the effective clinical application of NFkB modulators in COVID-19 is hampered by a number of factors that must be taken into consideration. This paper therefore explored the modulation of the NFB pathway as a potential strategy to mitigate the severe morbidity and mortality caused by COVID-19. The paper also discusses the factors that form the barrier, and it offers potential solutions to the various limitations that may impede the clinical use of NFkB modulators against COVID-19. This paper revealed and identified three key potential solutions for the future clinical use of NFkB modulators against COVID-19. These solutions are pulmonary tissue-specific NFkB blockade, agents that target common regulatory proteins of both canonical and non-canonical NFkB pathways, and monitoring clinical indicators of hyperinflammation and cytokine storm in COVID-19 prior to using NFkB modulators.

The spread of the COVID-19 disease to Africa has raised concerns around the resultant effects on the fragile and non-resilient health systems. Malawi reported its first COVID-19 cases in early April 2020 at the time of the country’s political turmoil, as the courts ruled for a re-run of presidential elections in July 2020 due to irregularities observed in the May 2019 elections. Therefore, assessing the implications of politics on the COVID-19 health systems preparedness is critical to design health systems strengthening efforts during the pandemic. We applied the WHO health systems framework to assess the implications of politics on the COVID-19 on the Malawi health systems preparedness. There was the population’s lack of trust in government hampering government efforts, which posed as a huge concern for Malawi to navigate through the pandemic including the health systems preparedness for the pandemic. This, coupled with mass demonstrations by the public disagreeing with the Lockdown and health service providers put across their COVID-19 related demands. The political environment and the trust people have in the government determines a country’s response to a pandemic. In a pandemic situation like COVID-19, the government’s ability to coordinate the various key stakeholders while instilling trust in people remain critical in strengthening health systems to contain and mitigate the pandemic. However, the Malawi political turmoil highlighted in this paper derailed the process and efforts to contain the and timely prepare the health systems to manage the pandemic whilst maintaining its core functions of delivering essential health services. Therefore, governments should consider the effects of political challenges in supporting a country’s health system to prepare for pandemics.

Multidrug‑Resistant Tuberculosis (MDR TB) is a threat for the future control of TB disease. In Indonesia, the success rate of MDR TB patient recovery is still very low, following the still low recovery rate of TB patients. This paper aims to discuss the trial result of message delivery containing knowledge and motivation to the MDR TB sufferers. There are about 34 MDR TB patients participating in this research. During the research, everyone received a message in their handphone or the handphone of their family members every day, contained information on medication and motivation to comply with the medication. At the end of the research, the measurement on knowledge and attitude, on the compliance with medication, and on the compliance with laboratory examinations was conducted. The results were compared with the assessment before this intervention was conducted. Out of 32 patients that managed to complete the intervention, the average means of their knowledge and attitude increased significantly. The average mean of knowledge before the intervention was 9.74 to become 10.94, and the average mean of attitude was from 7.06 to become 18.47 (P0.05). Meanwhile, the medication compliance score and the laboratory examination compliance score also changed significantly (P0.05). SMS delivery routinely even in a short period of time managed to change knowledge and motivation of MDR TB sufferers. To conclude, it is necessary to develop recent technology effort in order to scaling‑up MDR TB patients. Existing social channels in the community must be used intensively to reduce this disease negative impact.

A paradigm change in patient health care toward telemedicine services was necessary in 2020 due to the COVID‑19 pandemic, which broke out at the end of 2019. Theories used in determining the determinants of telemedi‑ cine utilization are various theories. Research conducted on the use of telemedicine still has doubts about the basic theory used in analyzing the factors that influence telemedicine, especially during the Covid‑19 pandemic. The goal of this study is to outline the fundamental principles of telemedicine utilization during the Covid‑19 outbreak and the variables that affect it. This Literature Review uses the scoping review method with the tool procedure, namely PRISMA. Based on the conducted literature review, there are 12 scholarly papers addressing the variables that affect the utilization of telemedi‑ cine services. During the Covid 19 epidemic, more individuals in many nations used telemedicine services. Anderson's theory of health care use and the idea of technology adoption or acceptance serve as the foundational theories for forecasting the variables that affect the use of telemedicine. The utiliza‑ tion of telemedicine is influenced by 29 different factors that come from different theories. The desire for health, exposure to COVID 19, co‑morbidities, social media usage, avoiding contamination, time efficiency, ease of use of services, social impact, and hedonic incentive are among the factors associ‑ ated to the COVID 19 pandemic.

Background: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from fortyone countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

The ongoing COVId-19 pandemic has highlighted the critical importance of Infection prevention practices among healthcare workers. Prioritizing this crucial aspect of healthcare can mitigate the spread of infectious diseases and ensure the well-being of our healthcare heroes and their communities. The purpose of the research was to investigate the knowledge and practice of Infection prevention and control. The study was a cross-sectional study that used self-administered paper-based questionnaires. The study sample of 316 eligible healthcare workers were selected using stratified sampling. data was entered into EPI Info version 7.2 and exported to SPSS version 27 for analysis. The ethics committees of the University and the Hospital approved the study. The majority of participants 116 (36.7%) were nurses. The mean age was 34.79 years ± 8.37, 118 (37.30%) were male while 198 (62.7%) were female. Only 169 (53.9%) knew the recommended duration for hand washing. 132 (41.8%) of healthcare workers believed needles should be recapped following use. Healthcare workers were twice as likely to wash their hands before contact and five times more likely to wash their hands after contact with a patient, their bedding, or after a procedure (AOR 1.82, 95%CI 1.04-3.20), (AOR 4.51, 95%CI 1.76-11.54) respectively. Personal protective equipment (PPEs) were twice as likely to be unavailable (AOR 2.39, 95%CI 1.31‑4.37). The findings revealed suboptimal knowledge and practice of hand hygiene indicating the need for healthcare workers to be trained on IPC. PPE(s) must be provided for healthcare workers to improve compliance with IPC practices.

Methicillin‑resistant Staphylococcus aureus(MRSA) infection is considered one of the nosocomial infections that can infect patients and healthcare workers(HCWs) and negatively affect the quality of care provided in the hospital. Evaluate the knowledge of HCWs regarding the prevention of MRSA infection in Thi-Qar Governorate.A descriptive cross-sectional study was conducted for 362 HCWs randomly selected from four hospitals and distributed as follows: 125 from Nasiriyah Teaching Hospital, 80 from Al-Hussein Teaching Hospital, 80 from Al-Haboubi Teaching Hospital and 77 from Souk Al-Shuyoukh General Hospital during the period from October 1 (2022) to May 1 (2023)and data was collected by using self-reported paper-based questionnaires. Our study showed 68.8% of HCWs enjoyed a moderate level of knowledge, and there was a strong correlation (P-value 0.05), between knowledge and some sociodemographic and occupational characteristics of the participants, which include age, educational level, job title,years of service and workplace in the hospital. Additionally, a relationship between knowledge and the source of the MRAS information was demonstrated which is a highly significant association between the total knowledge score and the sources of information. The knowledge of MRSA infection prevention among HCWs was moderate.

Mauritius does not have community health workers trained in identifying risk factors for hearing loss or in referring patients for diagnostic testing. It is crucial to gather information about the knowledge of and attitudes toward hearing loss among community health workers before involving them in the identification and intervention of hearing loss in Mauritius. To describe the knowledge of and attitudes toward hearing loss among community health workers in Mauritius. A descriptive survey design with quantitative analysis was used. Using non-probability purposive sampling, 125 community health workers which included 94 community health officers and 31 community‑based rehabilitation officers were recruited from the five catchment areas of the public healthcare sector. Participants filled in a 15‑item paper-based questionnaire on the knowledge of and attitudes toward hearing loss. The questionnaire was internally consistent, with Cronbach alpha scores of 0.759 and 0.863. The overall knowledge of community health workers regarding risk factors and the identification of hearing loss was poor (38.3%). 92.6% of community health workers reported positive attitudes toward hearing loss. General knowledge of hearing loss (P=0.015) and knowledge of risk factors and identification of hearing loss (P=0.005) were significant predictors of attitudes toward hearing loss. Knowledge of and attitudes toward hearing loss were significantly associated with working experience and practice setting (P=0.004). There remains a need to educate community health workers about the risk factors and identification of hearing loss to ensure timely diagnosis and management of hearing loss at the community level.

On 20th September 2022, Uganda declared the 7th outbreak of Ebola virus disease (EVD) caused by the Sudan Ebola strain following the confirmation of a case admitted at Mubende Regional Referral Hospital. Upon confirmation, the Government of Uganda immediately activated the national incident management system to initiate response activities. Additionally, a multi‑country emergency stakeholder meeting was held in Kampala; convening Ministers of Health from neighbouring Member States to undertake cross‑border preparedness and response actions. The outbreak spanned 69 days and recorded 164 cases (142 confirmed, 22 probable), 87 recoveries and 77 deaths (case fatality ratio of 47%). Nine out of 136 districts were affected with transmission taking place in 5 districts but spilling over in 4 districts without secondary transmission. As part of the response, the Government galvanised robust community mobilisation and initiated assessment of medical counter measures including therapeutics, new diagnostics and vaccines. This paper highlights the response actions that contributed to the containment of this outbreak in addition to the challenges faced with a special focus on key recommendations for better control of future outbreaks.

There has been significant progress with regards to winning the fight against HIV globally, particularly due to the introduction of antiretroviral therapy (ART). COVID‑19 threatened to derail gains in the fight against HIV. As we have started to see with studies on COVID‑19 and HIV, there is a need to ‘provide an in‑depth view’ in understanding the dynamics between the two epidemics, especially in sub‑Saharan Africa. We, therefore, undertook a systemic review of existing literature to synthesize the effects of COVID‑19 on the utilization of HIV services in sub‑Saharan Africa, the literature on the risks associated with HIV during the COVID‑19 pandemic, and lastly, the innovations and strategies adopted to continue receiving treatment in sub‑Saharan Africa. We conducted a systematic review of studies published between 2020 and April 2022. We searched for relevant sub‑Saharan studies in the following databases: PubMed, Google Scholar, J‑STOR, and Science Direct. The review followed the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines. The search identified 647 papers, and after screening, 41 were in line with the inclusion criteria and were included in the review. There was evidence of the negative effects of COVID‑19 on reducing HIV testing, ART treatment, and HIV prevention services. There is evidence pointing to the need for people living with HIV to be prioritized for COVID‑19 vaccinations. Innovations and strategies implemented to mitigate the effects of COVID‑19 on HIV services include community‑based ART distribution, multi‑month ART dispensing, the use of digital technologies, and the use of the already existing HIV infrastructure to fight COVID‑19. It is still imperative that future studies explore the predictors of utilization of HIV services in the advent of COVID‑19.

Background. Menstruation’s effects on workplace productivity and its impact on women’s careers are rarely discussed in public discourse. This paper presents an analysis of thirteen women’s accounts of their menstrual experiences at work. Objectives. The study aimed to understand women’s lived experiences of menstruation in the workplace in Namibia and to make recommendations for best practices and policy formulation to help female employees cope with menstruation at work in Namibia. Materials and Methods. The study adopted a qualitative, phenomenological narrative inquiry research design, and thirteen participants working in various institutions and companies in Namibia were selected through a snowball sampling procedure. Individuals who agreed to participate in the study were given a link to a Google document containing reflective questions. Results. Thematic analysis was used to analyze the narratives. The study findings show that most participants experienced various menstrual-related symptoms ranging from unbearable physical pain or discomfort to heavy bleeding and psychological distress. Menstruating women face workplace challenges, such as a lack of emergency sanitary products and unsupportive superiors. Conclusions. Based on the narratives analyzed, we conclude that menstrual-related symptoms affect work productivity. Participants highlighted that they perform better and are considerably more productive on their non-menstrual days. Participants advocated for a shift in policy to allow flexibility to work from home or get menstrual leave when experiencing severe menstrual symptoms. Such a change will go a long way in making the workplace more accommodating to women.

Background. The knowledge, attitudes, and practices (KAP) of people during the coronavirus pandemic are pivotal to the uptake of recommended preventative strategies. Objective. This paper describes the Malawian KAP related to coronavirus and associated public health measures. Methods. This was a multi-site cross-sectional survey where data was collected through personal one-on-one interviews in nine Malawian districts over 3 weeks (5-25 October 2020). 521 participants (18 years) were enrolled to answer a questionnaire. Results. We found that all respondents were aware of the ongoing coronavirus pandemic with the majority using the Radio. 75% of participants displayed knowledge of all key symptoms of coronavirus disease (cough, fever, and shortness of breath) and additionally, the majority of participants (97%) knew enough to take some sort of intervention (calling a hotline or visiting the nearest hospital) if they developed symptoms. Participants also demonstrated a high perception of the risk of coronavirus, where 60% believed to be susceptible to the coronavirus under the current preventative measures, and 50% believed they would die from the infection. Communities displayed a high perceived effectiveness of all preventative measures, with “hand hygiene using soap and water” being perceived as effective by the majority of respondents. Although the majority of the participants (80%) were willing to self-isolate at home, various barriers to home isolation were raised which would ultimately influence their ability to do so. Conclusions. Baseline community psychosocial and behavioral information which influence the adoption of public health measures in Malawi has been highlighted alongside recommendations for best practices.

In recent years, health partnerships have shared infection prevention and control innovations between United Kingdom hospitals and Low-Middle-Income Countries. However, none had focused on antimicrobial stewardship (AMS), a core component of tackling antimicrobial resistance (AMR). This paper documents an effective approach to developing a program to increase AMS capacity in four African countries: Ghana, Tanzania, Uganda, and Zambia as part of the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) program. A systematic approach was applied to assess gaps in AMS interventions and inform the development of the CwPAMS program through deskbased assessments, including National Action Plans on AMR, online focus group meetings, and expert advisory group reviews. Twelve partnerships were selected for the CwPAMS program. AMS support tools were developed based on recommendations from the scoping, including an AMS checklist tool, a healthcare worker knowledge and attitudes questionnaire, and an antimicrobial prescribing app to support clinical decision-making. Training workshops on AMS were developed and delivered to volunteers in Africa and the UK using a train-the-trainer model. The tools and workshops facilitated capacity building for AMS through the generation and strengthening of knowledge, skills, commitment, structures, systems, and leadership among stakeholders in the UK and Africa. The overall average rating assigned to the program following independent evaluation using the Organisation for Economic Cooperation and Development Assistance Committee Evaluation Criteria was very good. The evaluation also highlighted that the majority of the HPs (75%) focused on AMS and/or improved prescribing practice; all HPs have developed and implemented AMS strategies, guidelines, and tools within their hospitals; and NHS staff were able to translate the knowledge and skills they had received early on in the program into clinical practice in response to COVID-19 challenges./p

Introduction: Gestational diabetes mellitus (GDM) is a global problem that occurs in the world. This case occurred in pregnant women at 24-28 weeks of gestation. The global prevalence of GDM varies widely from 1% to 28%. Objective: The purpose of this study is to describe the prevalence of GDM in Asia and the risk factors for GDM. Materials and Methods: This research method used a systematic review for observational studies. The research inclusion criteria were original English papers, with full text published in peerreviewed journals. Method of 23 international articles in 2012-2022, which have articles that meet the requirements to be researched subjects regarding the description of the average prevalence of GDM cases in Asia and the risk factors for GDM. Results: The results of the study found that the lowest prevalence of GDM was in India at 1.9%, and the highest prevalence was found in Australia at 30%. The average risk factors for GDM are a family history of DM, BMI 25 kg/m2, multiparity and history of GDM in previous pregnancies, and history of abortion. The results of a journal review also show that mothers who give birth to GDM have a 48% risk of developing DM in the future. Conclusion: Based on the conclusion in this study, with the wide variation in GDM prevalence rates, it is better to set a GDM risk factor score so that other health services can use these indicators as the gold standard for screening GDM.

Introduction: Microplastics are plastic particles with a microscopic size of 5 mm in diameter. Microplastics are new contamination of the environment and can be bad for health. Objective: This paper aims to examine the presence of microplastics in the Indonesian environment based on the results of research in 2022 and its effects on health. Materials and Methods: Systematic review based on the results of research journals published in 2022. Journal obtained from a search on Google Scholar with keywords “microplastics”, “microplastics in Indonesia”, and “effect microplastic to health”. Results: The results of a review showed that the research location was dominated in East Jawa. The presence of microplastics in the environment in Indonesia is most widely studied, namely in river and sea sediments. The forms of microplastics identified are fiber, fragment, film, pellets, granule, foam, filament, and bead. In microplastic research on the environment in Indonesia in 2022, as much as 16% analyzed plastic polymer types. The study that identified the number, shape, and color of microplastics using visual methods with a microscope was 84%. Research on the effects of microplastics on health is still little done. Conclusions: Microplastics are widely studied in sediments, water, food, and air. Microplastics in the environment in Indonesia have been identified in number, shape, color, and polymer type. There have not been many studies that have conducted an analysis of the type of polymer. The environment in Indonesia has been polluted by microplastics that can have an impact on health.

Background: The successful integration of cervical cancer screening service (CCASS) into primary healthcare’s routine services depends on locality-specific and context-based service determinants. Objective: This paper aims to identify the abovementioned determinants and discusses how health administrators can manage their influence on CCASS delivery at the primary healthcare level. Methods: We conducted in-depth face-to-face interviews using a structured questionnaire with CCASS nurse providers and managers in four randomly selected primary health facilities. Information on the method(s) of screening utilised, the challenges faced, and the changes observed in CCASS provision were collected. Service managers were asked how they managed unplanned CCASS disruption, factors influencing CCASS replication, and aftercare support to cancer-affected women. Nurse providers were interviewed on the management of CCASS awareness and critical changes required to sustain CCASS service effectiveness. We used a constant interactive and inductive approach for data analysis. Results: Nine thematic categories of CCASS determinants were identified: ‘cultural’, ‘socioeconomic’, ‘individual’, ‘health system’, ‘evidence-based operations’, ‘outcome-based resourcing’, ‘workflow improvement and standardisation’, ‘inclusive partner’s management’, ‘utilisation’. These determinants were grouped into three domains: ‘conceptual’, ‘outcomes’, and ‘growth’ domains, to correspond to clusters of determinants that are likely to influence the CCASS lifecycle in its formative, continuous delivery or productivity, and reproductive phases. Conclusions: The findings show that sustaining an efficient integrated CCASS delivery at the PHC level requires phase-appropriate continuous adaptive improvements of service determinants within that locality.

Background: Historically, paper-based laboratory reports were delivered by couriers to health facilities resulting in post-analytical delays. As a result, short message service (SMS) printers were deployed to fill this gap, with the global data service platform (GDSP) being primarily used to facilitate deployment. In addition, these printers generate binary and quantitative information that can be used to assess utilization. Objective: The objective of this study was to determine the costs and utilization of the SMS printer program in South Africa. Methods: A cost analysis for 2020 was undertaken. We determined annual equivalent costs (AEC) for staffing, printers, fixed costs related to the national coordinator, consumables, travel costs, database support/hosting/dashboard development, printer repairs, and results transmission. The main outcome of interest was the cost per SMS printer result delivered. Data were extracted to assess utilization as follows: i) months active (based on internet protocol data); ii) signal; iii) battery strength. Results: There were 4,450,116 results delivered to printers that were situated at 2232 primary health care facilities. An AEC of $687,727 was reported, with a cost per result delivered of $0.1618. The SMS printers contributed 73.52% to the total AEC. Overall, 90% of the printers were GDSP based, of which only 69.5% were determined to be active. The majority of active printers reported a signal strength of ≥60% and a battery strength of ≥6 volts. Conclusion: Although the SMS printer program has the potential to reduce post-analytical delays, pathology services should migrate to an end-to-end electronic interface to improve patient care.

Background: Whether health aid has a positive, negative, or no effect on the health status of recipient countries is controversial. Objective: The current paper examines the long-run effect of health aid on health status in low-income countries. Methods: The long-run health function was estimated using infant mortality as a proxy for health status and panel data constructed from 34 low-income countries from 2000 to 2017. For the estimation, fixed effect, random effect, and Hausman-Taylor estimators were employed. Results: The estimation results indicate that health aid has a beneficial and statistically significant long-run effect on the health status of low-income countries. Doubling health aid saves the lives of 44 infants per 1000 live births in the long run. Conclusion: This study shows that health aid could be one of the best interim tools with which the health status of low-income groups could get improved and helps meet the target of universal health coverage. Despite the favorable effect of health aid observed in this study, recipient countries need to find ways of promoting surrogate domestic health financing systems, as external assistance cannot be an everlasting means of improving population health.

The gap in maternal health outcomes, access and utilization between the haves and have-nots continues to be a challenge globally despite improvements over the past decade. Though Ghana has experienced steady gains in maternal health access and utilization over the years, maternal outcomes, on the other hand, remain poor. In this regard, it is essential to know how various groups in the population achieved improvements and whether some women continue to be disproportionately disadvantaged. The paper performs an analysis of cross-sectional data from the 2017 Ghana maternal health survey to examine the existence of the inverse care law in maternal health services in Ghana. Using descriptive techniques and multivariate logistic regression models the study reveals a pro-rich and pro-urban gradient in the use of hospital facilities for delivery and antenatal care attendance — also, regions known for their high levels of poverty feature significantly lower rates of hospital deliveries. The paper concludes by stressing that unless policies are changed to accommodate these groups, overall gains in maternal health will continue to be incremental.

Although globalization has been advantageous in facilitating the free movement of people, goods, and services, the ease of movement of cross-border pathogens has increased the risk of international public health emergencies in recent years. Risk com-munication is an integral part of every country’s response during public health emergencies such as the coronavirus disease (COVID-19) pandemic. To effectively increase adherence to guidelines during health emergencies, it is essential to understand the impact of social, cultural, political, and environmental factors on people’s behaviours and lifestyles in any given context, as well as how these factors influence people’s perception of risks. During the recent response to the COVID-19 pandemic in Nigeria, the need to comprehend these influences was pronounced, and these influences ultimately shaped risk communication in Nigeria. We have identified risk communication challenges in Nigeria based on sociocultural diversity, the complexity of the health system, the impact of social media on communications, and other contextual factors surrounding multisectoral partnerships. To achieve global health security, these challenges must be addressed in resource-constrained countries like Nigeria. In this paper, we emphasize the need to contextualize risk communication strategies in order to improve their effectiveness during health emergencies. In addition, we urge increased country commitment to a multi-hazard and multisectoral effort, deliberate investment in subnational risk communication systems, and investments in capacity building for risk communication activities.

Background: The axillary nerve and posterior circumflex humeral artery are compressed in Quadrangular Space Syndrome (QSS), which can be treated with conservative approaches or surgical decompression in recalcitrant instances. There are no clear guidelines for determining which surgical method is optimal for treating QSS and other disorders that mirror QSS. Objective: The goal of this study is to grade and review past, current, and planned medicinal and surgical care modalities for QSS. Materials and Methods: The review protocol is registered with PROSPERO (ID: CRD42022332766). To identify recent advances in the methods/techniques of medical and surgical management of QSS, PubMed and Medline databases were searched until March 2022 for publications, including case studies, case reports, and review articles, using medical subject headings terms like quadrilateral space syndrome, surgical management, and medical management. Throughout the study, all the authors scrupulously followed a well-developed registered review process and the risk of bias in systematic reviews guidance tool. Data on proposed medical and surgical management methods/techniques were compiled, and each was analyzed based on the underlying neuro-vascular systems. Results: There were 88 items found in the first search. Following applying the inclusion and exclusion criteria, 16 papers were chosen for synthesis in the review study after a thorough assessment. Three studies (conservative and advanced) focused on medical care of QSS, while 12 articles (prior, current, and newer) focused on surgical management of QSS. Only four of the 15 studies reviewed proposed different surgical approaches/techniques for surgical decompression in QSS. Conclusions: There were two regularly used surgical procedures discovered, one anterior/delto-pectoral and the other posterior/ scapular. The anterior route is more technically straightforward and can be employed for surgical QSS decompression.

Few studies have looked at the psychological mechanisms that govern soccer officials’ performance to this point. The main goal of the study is to identify age-related changes in mental toughness among officials. Sixty active national officials were chosen at random from the All-India Football Federation’s national officials’ roster (AIFF). Group A is 25-30 years old, with a mean and SD of 27.4±3.39 (lower age group); Group B is 31-35 years old, with a mean and SD of 31.8±1.28 (middle age group); and Group C is 36-40 years old, with a mean and SD of 37.6±1.98 (higher age group). The Psychological Performance Inventory (PPI), developed by James E. Loehr in 1982, was chosen as the research’s test item. This instrument evaluates seven aspects of mental toughness, including self-confidence, negative energy control, attention control, visualisation and imagery control, motivation, positive energy control, and attitude control. One-way analysis of variance (ANOVA), with a significance threshold of 0.05, was used as the statistical approach to assess the study’s hypothesis. The finding of the research paper shows no significant difference among various groups.

Hospitals in today’s healthcare system are under pressure to boost their competitiveness. A number of studies have shown the disconnect between corporate culture and the enhancement of healthcare professionals’ performance. While it is well accepted that an organization’s culture has a substantial impact on the performance of its health care professionals in clinical practice, the mechanisms by which culture might enhance health care professionals’ performance remain unclear. This paper draws on 22 literature reviews and database searches using keyword syntax from ScienceDirect, Pubmed, Google Scholar, and other relevant publications published between 2011 and 2021. Research in the field demonstrates that a company’s culture may influence the efficiency and effectiveness of its healthcare employees. This overarching issue was dissected into the following themes: nurse performance mediated by discipline; the existence of cultural groups; a central focus on health care professional management; and individual, organizational, and psychological aspects. The optimal performance of nurses and the outcomes of patient care are contingent on management in the health care business knowing the cultural factors that exist in the workplace.

Health systems at all levels are under pressure to provide comprehensive and high quality of care based on the best evidencebased interventions. The kangaroo mother care (KMC) is one way to care for Low Birth Weight babies (LBW) especially in developing country where the rates of preterm and LBW neonates are higher and the resources are limited. The purpose of this paper is to explore healthcare providers’ perspectives of kangaroo mother care implementation in perinatology ward in the rural surgical hospital of East Java Province, Indonesia. We conducted an in-depth interviews to identify KMC implementations. Ten healthcare providers engaged with KMC were interviewed. Data was analyzed using a thematic analysis. Healthcare providers reported positives perceptions of KMC and acknowledged their important roles to give education. The barriers in implementing the KMC including the level of knowledge and the age of the mother of LBW babies. KMC as a method of treating LBW babies is effective intervention care of preterm and LBW babies. This research provides information regarding the need of supports from all levels in KMC implementation.

Introduction. The proliferation of the oral care industry has made it more challenging for shoppers to zero in on the best possible toothpaste for their preventative requirements. It also makes the toothpaste’s various components safer. Objective. The researchers set out to evaluate the state of information about the biological properties and cytotoxicity of adult toothpaste so that they might make some informed recommendations. Methods. A scoping review of research published between 2015 and 2020 according to PRISMA guidelines was performed. Results. In vitro clinical trials account for 44% of the papers, in vivo clinical trials for 25%, systematic reviews for 19%, and meta-analyses for 12%. They have active chemical components that have been shown to be antimicrobial, anti-inflammatory, or desensitizing. Herbal toothpaste has these characteristics and is very secure to use. Toothpaste with sodium lauryl sulfate has been found to be harmful. Conclusions. Scientists have investigated the biological effects of a wide range of chemically active compounds and plant extracts. Herbal toothpaste, it has been discovered, is both efficient and secure. Companies making toothpaste should be required to clearly label the product’s qualities, active ingredients, and potentially harmful ingredients on the packaging.

Background: The purpose of this paper is to investigate the primary variables associated with the COVID-19 disease and to demonstrate how to evaluate the effect of the earlier consideration of the containment measure and the massive testing policy on controlling the spread of this pandemic. We introduced and analyzed, for the first time to our knowledge, a new variable referred to as the Gap, which was defined as the time between the appearance of the first case and the implementation of the containment measure. Methods: A correlation, linear, and nonlinear regression-based statistical analysis was conducted to determine the impact of numerous variables and factors on the spread of this pandemic. Results: 81.3% of the variability of total cases was explained by the variability of total tests, and 72.3% of the variability of total deaths was explained by the variability of total cases. In addition, we have constructed significant nonlinear models that explain 97.8% of the total cases’ information and 89.4% of the total deaths’ information as a function of the Gap variable. Furthermore, we have found no correlation between the total number of tests and the fatality rate. Conclusion. Consideration of earlier containment is an effective measure that enables the prevention of a catastrophic disease spread scenario. In addition, the massive testing policy has no effect on the fatality rate. However, the performance of tests is highly effective at detecting new cases earlier, before they infect a large number of individuals, and is also an effective method for controlling the spread of this disease.

This paper investigates the impact of media Campaign on the prevention and spread of Lassa fever in Ebonyi state. 354 respondents were randomly selected from six rural communities in the state as study sample, while structured questionnaires was used for collecting data. SPSS version 20.0 was used to analyse the data. Results of Analysis reveal that the media campaign has rural reach but has little or no impact. The results also reveal that the campaign failed to create appropriate awareness of the disease, its preventive /curative health behaviours. It further reveals that there are no health behaviour modifications among the people because of the campaign. Therefore, this paper recommends the modification of media contents to incorporate the required preventive/curative health behaviours. Secondly, mandatory mass media awareness campaign and jingles in every news hour is recommended.

This systematic review was conducted to identify, evaluate and characterize the overall progress of health economics research conducted for Africa. Health economics studies carried out from 1991 to 2020 for Africa were retrieved from the EconLit database using relevant searching strategies. According to the methodology of Preferred Reporting Items for Systematic Review and Meta-Analysis, qualified journal papers were included. Using bibliometrics, we ran a series of analyses on authorship, studied countries, affiliations, and countries of origin, journals, and research topics. A total of 2935 studies were screened, and 178 were included in this review. We observed that the determinants of illness is the most researched topics. The United States, World Bank, University of California Berkeley, are respectively the most influential countries, world organizations, and academic institutions in the field of health economics of Africa. HIV/AIDs is still the leading health issue in highly cited health economics studies in Africa. Health Policy and Planning is the most productive and academically influential journal, and Kenya is the most studied country by health economists among all African countries. African health systems are vulnerable compared to developed countries, as many of them are underfunded. The academic strength in Africa is much weaker than that of leading health economics countries. Even within the continent, the academic development and the attention it receives are uneven. More influential health economics studies of Africa should be published in addition to the disease focus of HIV/AIDS.

As the world battles the latest strain of the coronavirus known as COVID-19 characterized as a pandemic by the World Health Organization (WHO), “infodemics” – an excessive amount of (mostly untrue) information about the pandemic that makes it difficult to discern essential information – has been identified by the health body as one of the major obstacles to be tackled to win the war against the raging pandemic. In a bid to control spread of the virus, the WHO published a guideline on Risk Communication and Community Engagement (RCCE) to COVID-19, noting these responses are vital for containment. The COVID-19 pandemic is testing and stretching health systems and their ability to effectively communicate with their populations. Failure to communicate accurate public health facts could lead to losses of trust, reputation, economy, and lives. This paper turns its searchlight on nongovernmental and community-based organizations (NGOs and CBOs) in Africa, and how they handle infodemics in an information environment battling not just a health pandemic, but a hoax pandemic too. Methods: The study employed mixed method, with data drawn from Africanbased NGOs and CBOs via online questionnaire and interviews against the backdrop of the Situational Theory of Publics. Findings reveal, based on what NGO/CBO survey respondents report their local clients think, that many at the grassroots still do not believe COVID-19 is real, while others view it as government’s scheme to embezzle funds. NGO/CBOs therefore look to WHO and Health Ministries for accurate information. It concludes that RCCE with the public and atrisk populations help reduce confusion and builds trust in the public health guidance community members can take thereby restricting the disease spread as an outcome of the RCCE approach.

The effects of the COVID-19 pandemic have been far reaching across almost every sphere of life. Families, which are the basic units of society, have not been spared the ravages of the pandemic. Changes in family daily routines as a result of COVID-19 can affect spousal relationships, parenting and childcare practices. However, the extent to which the pandemic has affected parenting practices and family relationships in Ghana is not known. The goal of this study was to assess how parenting practices and family relationships have been influenced during the COVID-19 pandemic in Ghana. Data for this paper was drawn from an online questionnaire response from 463 participants in Ghana as a subset analysis from a multi-country study on personal and family coping system with COVID-19 pandemic in the global south. The mean score for pre-COVID-19 relationship with partner (36.86) was higher (p0.0001) than the mean score for during COVID-19 relationship with partner (35.32) indicating that COVID-19 has had negative influence on relationships. The mean score for pre-COVID-19 parenting (32.78) was higher (p0.0001) compared to the mean score for during COVID-19 parenting (31.40) indicating negative influence on parenting. We have predicted that participants whose coping levels were “Well” on the average, are likely to be doing well in relationship with partners and parenting practices during the COVID-19 period The challenging public health containment measures of the COVID-19 pandemic have negatively influenced the relationship between partners and parenting practices in Ghana.

Previous pandemics have had significant impact on psychological well-being of front-line health care workers. Issues such as fear of contracting the disease, high workload as a result of high numbers of infected cases, increased job stress and unavailability of personal protective equipment have been implicated in development of psychological distress in this subset of individuals. The aim of the present paper is to describe psychobehavioral responses of health care workers and potential predictors of emotional response at onset of COVID-19 outbreak in Nigeria. Cross-sectional web-based survey and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) were administered anonymously to 444 respondents comprising various categories of frontline healthcare workers. Stepwise multiple linear regression was used to determine predictors of anxiety scores. Participants were mostly young adults (mean age 38 years), females (57%), living with a partner (78.2%) and medical doctors (56.8%). Restrictions in clinical activities and use of hand sanitizers were commonest precautionary behaviors. Commonest emotional responses were anger and despair (27.0% and 25.7%), respectively. About 42.8% had clinically significant anxiety symptoms with highest burden among nurses. Perception of likelihood of 2nd wave (p=0.03), self-preparedness (p=0.04), gender (p=0.01) and cadre (p=0.02) were significant predictors of emotional response of anxiety. Study findings highlighted diverse psychological reactions of health care workers with a large proportion screening positive for significant anxiety symptoms. This has implications for planning a comprehensive psychosocial response to COVID-19 pandemic and for future pandemics among frontline health care workers in lowresource settings.

The novel coronavirus COVID-19 has known a large spread over the globe threatening human health. Recommendations from WHO and specialists insist on testing on a mass scale. However, health systems do not have enough resources. The current process requires the isolation of testees in the hospitals’ isolation rooms for several hours until the test results are revealed, limiting hospitals’ capacities to test large numbers of cases. The aim of this paper was to estimate the impact of reducing the COVID-19 test time on controlling the pandemic spread, through increasing hospitals’ capacities to test on a mass scale. First, a discrete-event simulation was used to model and simulate the COVID-19 testing process in Morocco. Second, a mathematical model was developed to demonstrate the effect of accurate identification of infected cases on controlling the disease’s spread. Simulation results showed that hospitals’ testing capacities could be increased six times if the test duration fell from 10 hours to 10 minutes. The reduction of test time would increase testing capacities, which help to identify all the infected cases. In contrast, the simulation results indicated that if the infected population is not accurately identified and no precautionary measures are taken, the virus will continue to spread until it reaches the total population. Reducing test time is a vital component of the response to the COVID-19 pandemic. It is essential for the effective implementation of policies to contain the virus.

Dissemination of research findings through the publication of one’s work or a group of contributors is an important part of the research process, as this allows the passing on of benefits to a much wider community. In whatever evocative form this dissemination may take, the onus lies on the author(s) to ensure adherence to the code of ethics as it pertains to the integrity of the information being put out. We publish because we want our findings to be adapted into practice and application, or in some cases may be relevant to policy makers in decision-making. To a large extent in the field of academia, successful publication improves opportunities for academic funding and promotion whilst enhancing scientific and scholarly achievement and repute. A situation may be compromised where intellectual contributions to a scientific investigation do not adhere to the four key guidelines of scholarship, authorship, approval and agreement as well as the protocols of ensuring good publication ethics. The objective of this review is to lay emphasis on universal standards for manuscript authorship and to fostering good practices. This in our view will bring authorship credit and accountability to the attention of our colleagues and readers at large. To achieve this, a systematic and critical review of the literature was undertaken. Electronic databases, academic journals and books from various sources were accessed. Several key search terms relating to responsible authorship, common authorship malpractices, conflict of interest, universal publication guidelines and other authorship related issues, were used. Only references deemed useful from relevant texts and journal articles were included. In this paper, the authors have sought to highlight the pitfalls researchers sometimes entangle themselves within an act of compromise thereby impinging on the ethical and professional responsibilities for the content of a paper under consideration. This article presents the case that authorship has a strong currency that brings not only personal satisfaction but also career rewards based on publication counting. In all cases described here, a universal standard for manuscript authorship will be critical in fostering good practices. As you write and review manuscripts, keep these good practices in mind, and consider ways to bring authorship credit and accountability to the attention of your colleagues and readers.

Skin-lightening is an aesthetic practice of global concern. By adopting a biopsycho-social approach, we consider the interplay between the biological, psychological and social factors that underpin the circulation and consumption of skin lighteners in South Africa. This paper reflects on biological aspects of skin lightening, interpersonal relationships, individual beliefs and expectations about the maintenance of health and well being that informs cosmetic practices. The paper seeks to examine claims made by historians (Thomas) and political philosophers and activists (Biko) that colonialism and apartheid in South Africa historically reinforced the use of skin lightening products in the country. The paper also investigates the role of media in staking out the boundaries of beauty. We argue that men and women practice skinlightening not only as a complex result of the internalization of global standards of beauty, but meshed with a national politics of race and colorism. Banning skin lightening products without understanding the biological effects but also the social forces that underlie their increased popularity will prove futile. Moreover, we must consider the immeasurable pleasures associated with lightening, and the feelings with achieving visibility in South Africa, a country that continues to wrestle with blackness.

National Public Health Institutes (NPHIs) are national-level institutions that can lead and coordinate a country’s public health system. The Africa Centres for Disease Control and Prevention (Africa CDC) considers NPHI development critical to strengthening public health systems in Africa. This paper describes how Joint External Evaluation (JEE) reports demonstrate the role NPHIs can play in supporting the goals of IHR compliance and global health security. This study is a secondary document-based qualitative analysis of JEE reports from 11 countries in the WHO AFRO region (Botswana, Ethiopia, Liberia, Mozambique, Namibia, Nigeria, Rwanda, Sierra Leone, South Africa, Uganda, and Zambia). Researchers found three distinct thematic areas: i) core public health functions, ii) governance, and iii) coordination, collaboration, and communication. These themes and their interlinkages, both in pairs and all three, were of importance in displaying the roles that NPHIs could play in the strengthening of health systems. The data suggests that NPHIs, though not always explicitly mentioned in the data, may have a vital role in strengthening health systems across Africa and their governments’ goals of achieving IHR compliance.

Integrated community case management (iCCM) of malaria, diarrhea, and pneumonia is a comprehensive, equitybased strategy to improve treatment access for underserved children under five years old. This paper presents data on cost of iCCM and incremental costs of mHealth enhanced supervision and supply chain management in Zambia. We collected cost data using three questionnaires applied at national, district, health facility and community levels. We interviewed 40 health facility supervisors and 75 community health workers. A provider perspective and an ingredient costing method was used. We entered and analyzed data in a customized excel costing tool. The result shows that total iCCM cost per patient contact was USD 18.43. The incremental cost of using the mHealth intervention per child contact for all iCCM conditions was USD 11.35. The incremental cost per treatment of diarrhea, pneumonia, and malaria with mHealth intervention was USD 9.58, USD 10.37 and USD 12.82. Program costs accounted for 67% of the total, and the largest share was associated with supervision estimated at 36%, followed by supply chain management at 27%. This study has provided valuable information to policy makers on how much it costs to implement iCCM program using mHealth interventions.

This paper reports on HIV related stigma based on results from an HIV legal environment assessment (LEA) within the Churches Health Association of Zambia HIV/AIDS program. We conducted 9 Focus Group Discussions and 20 Key Informant Interviews with key HIV/AIDS stakeholders that included representatives from network of Zambian people living with HIV. We administered a Survey Questionnaire to 337 people living with HIV (PLHIV) and 233 health workers. Quantitative data were analyzed using SAS v9.4; qualitative data was analyzed using QRS NVIVO version 11.0 Pro. Internalized stigma ranged between 20.8% and 31.8% of PLHIV; more among females than males. About one third (31%, n=104)) of the 337 participants reported that they were aware of being gossiped once, a few times, or often; more among females than males. 62.3%, 63.1%, and 55.1% of the 233 health workers said it was somewhat true or certainly true that in their catchment areas, PLHIV struggle to have an HIV test because of stigma, were hesitant to start ART due to stigma; told them that they had challenges taking their ARVs because of stigma respectively.

Recognition of, and acting on, Social Determinants of Health is crucial for reducing health inequalities and territorial disparities and hence improving health of the whole population. Although Sudan was among the first countries which adopted a roadmap for Health in All Policies, health inequity remains an important challenge for health makers in this country. This paper illustrates the urgent need to reduce health inequalities in Sudan by acting on Social Determinants of Health. Descriptive statistics and Principal Components Analysis were used to get summarized multidimensional data information. Statistical significance of differences was tested by Pearson’s chi-squared. A large territorial disparity was found between the 18 states. Infant mortality rate is more than three times higher in East Darfur (88.5) than in River Nile (28.1). Ratios of 1.9 and 1.6 were indicated for income and mother education respectively. A lower gap was seen for milieu (1.2) and gender (1.34). The difference was statistically significant for states (p-value

The female genital tracts harbor a wide variety of microorganisms’ knowns as microflora mostly constituted by lactobacilli, involved in the healthy state of the vagina without causing infection. Urinary tract infections (UTI) are frequent in pregnant women due to physiological and anatomical changes that occur during pregnancy. These infections can result to disabilities or serious health problems both for the mother and the new-born. Vaginal douching has been reported among risky practices associate with UTIs. However, this remains debatable and contradictory when other studies report the benefit effects of vaginal cleaning in infection prevention. The aim of this study was to assess pregnant women behaviors and practices regarding genital hygiene. This was a cross sectional descriptive study conducted on exhaustive sample of pregnant women coming for antenatal visits in Lafé Sub-divisional Hospital (SDH) and Baleng Catholic Health Center (BCHC) between 16 and 30 September 2013. Data were collected using a paper based standardized questionnaire directly self-administered after obtain a free consent. Overall, 80 pregnant women were enrolled. The majority of them had attended at least primary education (97.5%; n=78/80) and many were lived in couple (81.25%; n=65/80). Almost one on three participants identified antenatal consultation (ANC) as a key element to be taken into account by pregnant women. 70.1% (n=56/80) of women declared wearing undergarments in cotton. Regarding the daily vaginal douching behaviors, the majority (76.3%; n=61/80) of participants used the recommended gynecological measure, while the remaining use self-prescribed measures. Both genital parts (vulva area and vagina) were cleaned and use of water was mostly cited (63.8%; n=51/80). Almost one participant on four (n=29/80) use antiseptic solutions for genital cleaning. Antiseptic solutions were associated with water in 34.5% of cases (n=10/29), and in 65.5% (n=19/29) of cases it was used only for the vagina. Our findings suggest that knowledge and genital hygiene cleaning practices are acceptable among our study population. Risky practices such as use of antiseptic solutions and synthetic underwear’s were reported. Skills of health care providers on good hygiene practices for pregnant should be improved and community-based communication strategies need to be implemented to reach all women of child bearing age.

Pharmacogenetics holds great potential for improving the effectiveness of treatment modalities in infectious diseases by taking into account the genetic determinants of both the host and infectious agents’ individuality. Better utilization of resources and improved therapeutic efficiency are the expected outcomes of personalized medicine using pharmacogenetic and pharmacogenomics information made available by technological advances. However, there has been growing concern in the clinical community regarding the evaluation of the true benefits of these approaches. This perception is partly due to the limited number and perceived poor quality of economic evaluations in this field, and initiatives aimed at harmonizing and communicating strategies improving the quality of these studies and their acceptance by the clinical community are greatly needed. This paper reviews current literature of economic evaluations of pharmacogenetics interventions guiding pharmacotherapy in infectious diseases. PubMed and the NHS Centre for Reviews and Dissemination databases were searched using a combination of five broad research terms related to pharmacogenetic approaches, and papers relative to economic evaluations of pharmacogenetic interventions in infectious diseases retained for further analysis. Using these criteria, a total of 14 papers were included in this review. The area of economic evaluation of pharmacogenetic interventions in infectious diseases remains understudied and would benefit from greater harmonization. The main weaknesses of evaluations reviewed in this paper seem to be represented by poor evidence of pharmacogenetic marker validation, inconsistencies in the selection of costs and utility included in the economic models and the choice of sensitivity analysis. All these factors limit the overall transparency of the studies, greater acceptance of their results and applicability to diverse and possibly resourcelimited environments where these approaches could be expected to have the greater impact.

Air pollution has remained a major issue of concern over the years with serious toxicological effects on human health. This paper evaluates the comparison of estimates and describes the global burden of diseases related to air pollution in the regions of WHO from 1990 to 2015. The study uses existing data from IHME on global burden of diseases (Mortality and Disability Adjusted Life Years) related to air pollution such as Trachea, Bronchus and Lung cancer, COPD, Ischemic heart disease and Stroke. This study shows that air pollution is one of the major environmental risk factors for the global burden of disease in 1990-2015 and has remained relatively stable for the past 25 years. By region, the largest burden of disease related to air pollution is found in Western Pacific and South-East Asia, reflecting the heavy industry and air pollution hotspots within the developing nations of these regions. Moreover, the rates of Disability Adjusted Life Years increased because of increase in pollution, especially in South-East Asia region, African region, and Eastern Mediterranean region where populations are both growing and ageing.

Health education and promotion remains an integral part of public health. This paper details health promotion activities in Botswana since the establishment of the profession in 1988. It further describes health promotion infrastructure, investment in health promotion, human resource training and collaborations within the country. Infrastructure and services for health promotion in the country are mainly provided by government through educational institutions, faith based organizations, non-governmental organizations, general medical practitioners and mining companies complementing the Ministry’s efforts. More than 1000 health promotion cadres have been trained at certificate, diploma and degree levels by Boitekanelo College and the Ministry of Health through Serowe Institute of Health Sciences.

The aim of the paper is to describe the knowledge of mothers in Durban, South Africa, regarding risk factors of hearing loss in infants and their awareness of audiology services, and to describe their cultural beliefs about the risk factors for hearing loss in infants. A descriptive survey design with quantitative methods of analysis were used. Conveniently sampled mothers (n=102) receiving postnatal care for their infants from eight provincial clinics within Durban consented to participate, yielding a response rate of 48%. A questionnaire was used to collect the data and the Cronbach α was calculated yielding a score of 0.835, indicating good internal consistency and reliability of the questionnaire. Sixty percent of the mothers were aware of risk factors, such as middle ear infections, ototoxic medication and consumption of alcohol during pregnancy. Seventy percent were unaware that NICU/mechanical ventilation for more than 5 days, prematurity, rubella and jaundice are considered risk factors for hearing loss, implying a need to create awareness amongst mothers regarding such risk factors. Sixty percent (n=62) believed that bewitchment and ancestral curses can cause hearing loss. Cultural beliefs were associated with hearing loss, therefore, health professionals need to demonstrate cultural competence when providing audiology services, especially in a culturally and linguistically diverse countries such as South Africa. Although the mothers had an average knowledge about risk factors, two thirds did not know which professional to seek help from. There is a need to create awareness amongst mothers regarding the risk factors of infant hearing loss as well as audiology services in order to facilitate early detection and intervention. There is a need for health professionals to demonstrate cultural competence when working with their patients.

The aim of the paper is to explore factors associated with home or hospital delivery in rural Uganda. Qualitative interviews with recently-delivered women in rural Uganda and statistical analysis of data from the 2011 Ugandan Demographic and Health Survey (DHS) to assess the association between socio-demographic and cultural factors and delivery location in multivariable regression models. In the DHS, 61.7% (of 4907) women had a facility-based delivery (FBD); in adjusted analyses, FBD was associated with an urban setting [adjusted odds ratio (aOR) 3.38, 95% confidence interval (CI) 2.66 to 4.28)], the upper wealth quintile (aOR: 3.69, 95%CI 2.79 to 3.87) and with secondary education (aOR: 3.07, 95%CI 2.37 to 3.96). In interviews women quoted costs and distance as barriers to FBD. Other factors reported in interviews to be associated with FBD included family influence, perceived necessity of care (weak women needed FBD), and the reputation of the facility (women bypassed local facilities to deliver at better hospitals). Choosing a FBD is a complex decision and education around the benefits of FBD should be combined with interventions designed to remove barriers to FBD.

The purpose of this paper is to explore the perceptions of self-reported HIV testing and risk behavior among sexually active adolescents and youth in secondary schools in Kampala Uganda. This was a cross-sectional survey conducted between June and October 2010 among secondary school students in Kampala, Uganda. Forty eight (48) students across the 54 schools were purposively selected for the qualitative sub-study based on their responses to particular questions. We thematically analyzed 28 interviews for our qualitative study using Nvivo software. Drug and alcohol use coupled with peers pressure impaired students’ perceptions towards HIV risk and therefore increased their susceptibility to HIV risk behaviors. Of the 28 scripts analyzed, 82% (23/28) had ever had sexual partners, 79% (22/28) were currently sexually active, and 57% (16/28) had ever been tested for HIV. In conclusion, most adolescents interviewed did not perceive HIV testing to be important to HIV prevention and reported low perception of susceptibility to HIV infection. Development of an adolescent HIV prevention model is important in improving uptake of HIV services.

Shortage of healthcare workers in rural and remote areas remains a growing concern both in developed and developing countries. This review aims to synthesize the significant factors impacting healthcare professionals’ recruitment and retention in rural and remote areas, and to identify those relevant for developing countries. This paper included the following steps: exploring scientific literature through predetermined criteria and extracting relevant information by two independents reviewers. The AMSTAR tool was used to assess the methodological quality. Of the 224 screened publications, 15 reviews were included. Four reviews focused on recruitment factors, and another four reviews focused on retention factors. The remaining focused both on recruitment and retention factors. The most important factors influencing recruitment were rural background and rural origin, followed by career development. Opportunities for professional advancement, professional support networks and financial incentives were factors impacting retention. While the main factors influencing recruitment and retention have been largely explored in the literature, the evidence on strategies to reduce the shortage of healthcare workers in rural area, particularly in developing countries, is low. Further research in this field is needed.