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Introduction: paper currency notes, exchangeable fomite, that is continuously contaminated because of the poor handling and storage practices. Objective: the general objective of the study was to determine the bacterial contamination of paper currency notes possessed by food vendors around Mulago National Referral Hospital Complex. Methods: a total of sixty paper notes of six denominations (1000, 2000, 5000, 10000, 20000, 50000) were collected from different food vendors. Each note was preserved in a sterile falcon tube and transported to the microbiology lab for bacteriological examination. Data from questionnaires was analyzed using SPSS version 23 (IBM SPSS Statistics). Results: all sampled paper notes had bacterial contamination. The bacterial counts ranged from 4×102 cfu/ml to 6.8×109 cfu/ml, with the Shs.1000 notes having the highest average total bacterial load of 2.17×109 cfu/ml and highest average total coli form counts of 21.5×102 cfu/ml. The fifty thousand shillings note had no coliform detected. Of the analysed 60 samples, 27(45%) samples contained Staphylococcus aureus. None of the sampled paper notes had Escherichia coli. Conclusion: the study revealed that most of Ugandan paper notes are contaminated with bacteria including potential pathogens that cause disease in healthy individuals and opportunistic pathogens that may cause disease in hospitalized and immunocompromised patients. This study showed that the most contaminated note denominations were those of low denomination (Shs.1000 and Shs.2000) which had the highest bacterial count. The study revealed the paper currency notes were stored in different places where the commonest was the drawer and kept with different items, the commonest being pens. Hence, great care must be taken while handling money during the preparation and handling of food to avoid cross contamination.

This position paper is written in reference to the recent extensive media coverage of the report of the Independent Panel describing Harassment, Including Sexual Harassment, Bullying and Abuse of Power at UNAIDS Secretariat by several newspapers and authoritative journals such as Science and The Lancet. Unfortunately, none of these publications provide any clear evidence to support the accusations and merely repeat what are, in our view, unsubstantiated statements made in the report. Given the critical role that Africans have played in dealing with one of the most severe epidemics that the world has seen and the gravity of these charges, we believe it is essential to reaffirm that African voices and leadership is imperative for the global AIDS response.

Introduction: historically, programs aimed at making communities abolish female genital mutilation or cutting (FGM/C) consisted mainly of awareness campaigns on sexual reproductive health and rights and the enforcement of newly implemented laws. These types of programs or interventions appear to be only partially effective and sometimes yield unintended results, such as actually strengthening commitment to FGM/C or transforming it into a secret practice. A newer approach to change that is intended to account for the cultural meanings ascribed to FGM/C are alternative rites of passage (ARP). Amref Health Africa started adopting this approach in 2007. Since then, by a trial-and-error process lessons have been learned, that will be reflected upon in this paper. Methods: desk research was conducted on organizational data regarding all Amref Health Africa's efforts to end FGM/C. Ninety-four in-depth formal interviews were held with members from Maasai and Samburu communities in Kenya targeted through maximum variation sampling. And participant observation of significative events as well as daily pastimes took place during school holiday season at the end of 2016. Furthermore extensive informal talks were held with project donors, activists, journalists, members of other nongovernmental organizations, members of community services organizations, local government officials, high-ranking Dutch and US diplomats and senior members of the Anti-Female Genital Mutilation Board, which is part of the Kenyan Ministry of Public Service, Youth and Gender Affairs. On the basis of these data a framework on different positions on FGM/C was developed and published in early 2018. By reviewing the data again from a particular change management and public health perspective, by peer-debriefing within a multi-disciplinary research team and by explicating the lessons learned this paper adds to an overview that is of crucial importance to practitioners working to end FGM/C. Results: risk of exclusion, perceived loss of cultural identity, changing meanings ascribed to cultural practices, lack of precise knowledge about subjective (sexual) experience and negative stereotyping are reasons not to adhere to anti-FGM/C programs. Areas of concern are the role confusion with following-up on policing, perceived outsider interference and the intended prolonging of the transition phase into womanhood not being explicated and embedded with ARP. Aspects to enhance to lever change more effectively are education and school curriculum development, male involvement, new stylization of love relationships, monitoring and evaluation and inclusive aspects of religion. Conclusion: changing a culturally embedded practice such as FGM/C is inherently complex. Because the cultural meanings ascribed to this practice are also evolving, any intervention that is effective at present might become superfluous in the future. A holy grail approach to change simply does not exist. Change needs to be levered in a variety of ways while working on the alignment of all these efforts by regular and thorough quantitative and qualitative assessments of effects and side-effects and reflections on lessons learned.

Toxoplasmosis is a disease caused by a protozoal parasite: Toxoplasma gondii. This infection can cause severe illness when the organism is contracted congenitally or when it is reactivated in immunosuppressed people. In this paper we review for the first time prevalence and risk factors of T. gondii among pregnant women and HIV-infected adults in Morocco. A systematic review methodology was used to consult three databases: Pub Med, Science Direct and Google Scholar dated until 2015, regarding prevalence data and risk factors of infection among pregnant women and people living with HIV. Data collection and eligibility criteria were established in this paper. No statistical method was employed in this study. Our review resulted in a total of 6 publications meeting the inclusion criteria of prevalence and risk factors of toxoplasmosis in Morocco. Seropositive rates of T. gondii infection reach up to 51% in pregnant women. Risk factors that were reported included contact with soil, lack of knowledge about toxoplasmosis, and a low educational level. For HIV-infected adults, the limited data show a 62.1% prevalence rate of T. gondii .According to our review, there is still very little information on toxoplasmosis disease in pregnant women and HIV infected patients in Morocco. Further research on toxoplasmosis is needed to better ascertain the human disease burden in Morocco.

Introduction:the blended SORT-IT model uses a combination of online modules and teleconferences with local and international mentors to teach operational research. We modified SORT-IT to create the Acute Care Operational Research (ACOR) course directed to anesthesiology residents in Kigali, Rwanda. This course takes students from an initial research idea through submitting a paper for publication. Our viewpoint on entering this study was that ACOR participants would have adequate resources to complete the course, but be hampered by cultural unfamiliarity with the blended teaching approach. Methods:we conducted a qualitative analysis of the experiences of all those who participated in the ACOR course to understand obstacles and improve future course iterations. Six anesthesiology residents participated in the first iteration of the course, with 4 local mentors and 2 secondary mentors, one of whom was based at the University of Virginia, with a total of 12 participants. Semi-structured interviews were conducted with all participants and mentors, which were independently coded for topics by two reviewers. Results:there was a 50% publication rate for those enrolled in the course and an expected 100% acceptance rate for those who completed the course. Some reported benefits to the course included improved research knowledge, societal improvements, and knowledge exchange. Some reported obstacles to successful course completion included time limitations, background knowledge, and communication. Of note, only 4 out of 12 participants recognized cultural barriers. Conclusion:although successful in the sense that all participants completed their research project, ACOR did not fully solve the main issues hindering research training. Our results show that research training in low-resource settings needs a continuing and formal focus on the factors that hinder participants´ success: mentorship and time.

Adverse consequences of the coronavirus disease 2019 (COVID-19) vaccination which have been reported in scientific papers are varied. One possible but rare consequence is myocarditis, which may have a diversity of clinical manifestations. We report a case of a 70-year-old man who presented to the hospital for some syncope, 3 days after his first COVID-19 AstraZeneca Vaccination. Initial electrocardiogram (ECG) showed a long QT interval (QTc = 600 milliseconds). Laboratory tests revealed elevated troponin and lack of evidence of viral infection. Further investigations revealed the vaccine-induced myocarditis and arrhythmias linked to it. Within one week of magnesium treatment, the QT interval was completely corrected, and the patient discharged with no typical syncope attacks. This case like the previous reported one confirms that myocarditis is a complication of COVID-19 vaccine, but implies its clinical manifestations may be varied and even may happen after the single dose of vaccination.

Introduction:acute bronchiolitis is the leading cause of hospitalization in infants worldwide. However, little is known about the real impact of on society in terms of years of life lost due to this condition. The objective of the present study is to determine the Disability-Adjusted Life Years (DALYs) for acute bronchiolitis in infants in Colombia. Methods:data from the national epidemiological surveillance system were used to estimate DALYs, calculated from the sum of years of life lost and years lived with disability due to acute bronchiolitis in Colombia. A bootstrapped method with 10,000 iterations was used to estimate each statistical parameter using the package DALYs calculator in R. Results:in 2019, 447,434 years of life (confidence interval 95% 397,647- 512,759) were lost due to acute bronchiolitis in Colombian infants. The estimated rate was 34 DALYs/1000 person-year (95% confidence interval 30-39). Conclusion:our paper shows the high burden of disease associated with bronchiolitis in Colombia. Prevention strategies, such as acute bronchiolitis vaccination, to reduce morbidity associated with acute bronchiolitis should be encouraged in our country.

Double-J (DJ) stents have been widely utilized in urological practice. They are commonly used to relieve ureteral obstruction. Serious complications may occur when stents are left in place for long periods of time. In the present paper, we report a patient with a neglected DJ stent that had been inserted for five years after uterus-tumor surgery and led to a bladder stone. We report a case of a female who presented a bladder stone with a right DJ stent in the pelvic cavity. The stone was evident in radiological examination in an incidental finding. The treatment was transurethral cystolithotripsy. This case reminds us of the necessity of providing enough information and appropriate knowledge pertaining to the insertion of a ureteral stent. Transurethral cystolithotripsy is one of the treatment methods and can be suggested as a definitive method in consideration that it is a clinically effective and safe intervention.

Widespread vaccination provides a means for countries to lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. However, to date, Africa has secured enough COVID-19 vaccine doses for less than 5% of its population. With widespread vaccination not on the horizon for Africa, there is a strong emphasis on non-pharmaceutical interventions which include movement restrictions (lockdowns). This general COVID-19 pandemic response of imposing lockdowns, however, neglects to factor in non-fatal consequences leading to disruption socio-economic wellbeing of the society at large. The economy in most African countries can no longer sustain lockdown restrictions. Some studies have indicated that a hard lockdown statistical value of the extra lives saved would be dwarfed by its long-term cost. At the same time not responding to the threat of the pandemic will cost lives and disrupts the social fabric. This paper proffers ways to mitigate the both and advocate for better policymaking that addresses specific challenges in defined communities thus yield higher population welfare.

Introduction:Non-Communicable Diseases (NCD) are becoming a public health problem in Mozambique and wider sub-Saharan Africa, and are driving changes to guaranty lifelong follow up of patients within the health systems. Patient-Held Medical Records (PHMR) are an option for this follow-up in under-resourced health systems. We designed a study to assess the rate of retention and quality of conservation of the PHMR. Methods:we conducted a prospective observational study from November 2016 to October 2018 in a peri-urban hospital from in Mozambique. Consecutive newly diagnosed patients with cardiovascular disease were given PHMR. Data was collected after their first consultation and one year after. The retention and quality of conservation were assessed after 12 months. Results:overall 134 PHMR were given to patients (24;17.9% children and 77;57.5% female), of which 121 (90.3%) retained at 12 months (90.9% in good conservation state). Most patients had on average four visits to health facilities during the study, all registered in the PHMR. Retention could not be confirmed in 13 patients who did not return the PHMR. Conclusion:PHMR retention rates were high in an urban low-income setting in Africa, with high quality of conservation, thus supporting its use to replace hospital paper-based medical files. Specific research is recommended on acceptability, quality of information registered and patient´s perception.

One-third of the global burden of disease is attributed to surgical conditions yet, 5 billion people globally, lack access to surgery. The Lancet Commission on Global Surgery, Obstetrics, and Anesthesia (LCOGS) published guidelines for improving access by reducing catastrophic health expenditures (CHEs) by 2030. This is especially important in sub-Saharan Africa (SSA) where 90% of the extreme poor reside. In this paper, we provide a narrative review of four studies on CHEs for surgical care in SSA published since 2015. We discuss healthcare financing in the countries and summarize the authors' key findings of out-of-pocket payments (OOP) and CHEs. Briefly, the studies enrolled 130 to 300 patients and collected direct OOPs via chart review of health costs or patient interviews. Indirect costs were calculated from lost wages and transportation costs. CHEs were defined as health costs exceeding 10% of the GDP per capita or the household income. Despite healthcare being reported as free in all studies, 60%-90% of surgical patients had CHEs with all costs considered. OOPs persists for medicines and anesthesia that should be covered under any health insurance scheme. In some cases, indirect costs associated with transportation and wages were major drivers of CHEs for surgery. Without addressing these gaps in coverage, more people will risk impoverishment in seeking surgical care in SSA.

The COVID-19 pandemic could have a major impact on the capacity of health systems to continue the delivery of essential health service. While health systems around the world are being challenged by increasing demand for care of COVID-19 patients, it is critical to maintain preventive and curative services, especially for the most vulnerable populations such people living with chronic conditions like thallasemics. In this context and since the start of the SARS-CoV-2 health crisis, the National Blood Transfusion Center of Morocco has ranked among its priorities the need to maintain transfusion management for chronic polytransfused patients, particularly those with thalassemia. We report in this paper, the case of a thallasemic patient whose transfusion management was disrupted by the restrictive measures introduced by the Moroccan authorities and for which the National Blood Center of Morocco provided effective support.

In this paper, we report two cases of induced thrombocytopenia after the infusion of glycoprotein (GP) IIb/IIIa receptors antagonists, following a coronary angioplasty. The first patient is a 65-year-old woman, admitted with acute coronary syndrome requiring percutaneous angioplasty with stenting. The patient was given tirofiban + unfractionated heparin (UFH). Ten hours later, the patient revealed very severe thrombocytopenia and went into hemorrhagic shock (hematemesis and hematoma at the injection site). The patient was transfused with nine units of red blood cells (RBCs), 24 platelets pellets and 4 units of fresh frozen plasma (FFP). The second patient is a 76-year-old woman. She was admitted to hospital for acute coronary syndrome necessitating percutaneous angioplasty with stenting and a glycoprotein IIb/IIIa receptor antagonists, tirofiban + unfractionated (UFH). Four hours later, the patient presented with gingivorrhagia associated thrombocytopenia. She received six platelet pellets transfusion with well clinical and biological improvement. These two observations raise the significance of a close monitoring of platelet count after the initiation of GP IIb/IIIa antagonists infusion, which are sometimes responsible for life-threatening adverse events.

Fibromas are benign tumors of connective tissue common in the oral cavity but rare on hard palate. This paper reports on an asymptomatic, slowly growing mass on the hard palate of a 90-year-old lady, with a reported use of denture for two decades. The patient presented with a 2.2cm, smooth-surfaced, well-circumscribed nodule attached with a stalk to the palatal mucosa. After excision, the histopathological examination revealed a mass of fibrous connective tissue, covered by stratified squamous epithelium with focal low-medium grade hyperplasia and hyperkeratosis. These findings were consistent with irritation fibroma of hard palate, a rare entity, which should be considered as a possible diagnosis for tumors of the area by every physician.

Castleman's disease is a rare pathology, poorly understood. It is considered as a lymphoproliferative disorder, described for the first time in 1954, which may be confused with other causes of lymphadenopathy. We report in this paper the case of a young women presenting with left latero-cervical lymphadenopathy. All the investigations were negative except a large high-vascularized level II cervical lymphadenopathy. We performed a cervicotomy. The extemporaneous histological exam was non-contributive. We decided to perform a complete level II and III left cervical lymphadenectomy. The diagnosis of unicentric Castleman's disease was confirmed based on the final histological study of the specimen, and the absence of other cervical and extra-cervical lymphadenopathy. The patient is free of recurrence at the time of reporting this article.

The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.

The outbreak of COVID-19 has been unprecedented in speed and effect. Efforts to predict the disease transmission have mostly been done using flagship models developed by the global north. These models have not accurately depicted the true rate of transmission of SARS-CoV-2 in Africa. The models have ignored Africa´s unique socio-ecological makeup (demographic, social, environmental and biological) that has aided a slower and less severe spread of the virus. This paper opines on how the science of infectious disease modelling needs to evolve to accommodate contextual factors. Country-owned and tailored modelling needs to be urgently supported.

The ebola epidemic that raged in West Africa between 2013 and 2016 was the largest since the discovery of the virus in 1976. During this epidemic, more than 11,000 cases were notified with a lethality of over 67%. Several means of transmission have been described. The great difficulty noted during the epidemic was the estimation of the number of asymptomatic and pauci symptomatic cases, however there is evidence that this population has been in contact with the virus for some time. Thus, they could be a source for the spread of the epidemic. In this paper, we report in Guinea-Conakry three stories of probable pauci-symptomatic form of ebola disease that would have been the cause of massive infection in a population sorely tried by the epidemic between 2014 and 2015 in Guinea.

To the editors of the Pan African Medical Journal Since March 2020, the world has declared a global health crisis caused by the coronavirus COVID-19 pandemic. After Asia, Europe, the United States is the most affected. The main features described are pulmonary manifestations, however, this systemic infection seems to have a direct impact on the hematopoietic system. Many publications have documented the clinical, biological and radiological characteristics of COVID-19 infection, and several international societies have developed protocols for management and follow-up. In these recommendations, biological analysis and especially the complete blood count, represents a major tool in the diagnosis, monitoring, detection of severe forms, and hematological complications [1]. Quantitative hematologic abnormalities have been reported since the first papers, all blood cells can be affected during COVID-19, mainly leukocyte and platelet cells [2]. During asymptomatic forms or the incubation period, patients can manifest a moderate abnormality in the blood count, Qilin et al suggested the potential value of eosinopenia as predictors of early identification of COVID-19 [3]. Regarding symptomatic forms, Guan et al found in a large series of 1099 cases, a predominance of lymphopenia (83%), thrombocytopenia (36.2) and neutropenia (33.7%) [4]. In severe cases, these abnormalities were more prominent (96.1% versus 80.4% lymphopenia, 57.7% versus 31.6% thrombocytopenia and 61.1% versus 28.1% for leukopenia) [5]. Lymphopenia is the most common sign, in fact, the coronavirus attack directly and indirectly the lymphocytes by immune and inflammatory mechanisms [6]. The analysis of the lymphocyte count is therefore a reliable indicator of the severity, which can be really useful in the monitoring and therapeutic adaptation, moreover after clinical improvement the lymphocyte count is corrected [7]. Among recent studies, a meta-analysis, have reported the association between low platelet count (less than 30 109/l) and the increased risk of severity and mortality from COVID-19. The pathophysiologic mechanism of thrombocytopenia is multifactorial due mainly to disseminated intravascular coagulation, micro-vascular thrombosis and macrophagic activation syndromes, that can cause bleeding and poor outcome [8]. In summary, the blood count as a routine biological analysis, keeps a prominent role in the early diagnosis and follow-up of COVID-19 infection. The blood cells perturbations are seen as a prognosis factors, careful analysis and interpretation of lymphocyte and platelet count, allows not only to evaluate the prognosis, but above a clinician to adapt therapeutic care. Compared to specific inflammatory biomarkers tests (Lactate dehydrogenase, Interleukin, procalcitonin, etc.), the blood count remains a less expensive alternative, especially in countries with limited resources. Competing interests All authors declare no competing interests.

Cricoarytenoid joint arthritis is most frequently reported in Rheumatoid Arthritis and in other systemic diseases such as Sjogren's syndrome, Systemic Lupus Erythematosus, Ankylosing Arthritis, Juvenile Chronic Arthritis, and autoimmune hepatitis but it has not been reported in dermatomyositis. In this paper, we report the case of a 43 years-old woman treated for dermatomyositis who presented with hoarseness and severe odynophagia. The laryngoscopy revealed the presence of an extensive white swelling of the left cricoarytenoid joint with reduced mobility of the left vocal cord, consistent with left cricoarytenoid joint arthritis, which has not previously been described in dermatomyositis to our knowledge. Treatment with high doses of prednisone produced a complete resolution of the laryngeal symptoms.

To the Editors of The Pan African Medical Journal The unprecedented novel Coronavirus disease, COVID-19, which emerged in December 2019 has been labeled “disease X” by the World Health Organization (WHO) based on its rate and extent of spread as well as harsh ramifications. In response, different nations have adopted different management approaches hinging on various considerations, among them the WHO recommendations. Uganda has incorporated lockdowns, a measure that has affected schools, hospitals, businesses, places of worship, markets, public transport, and a rise in abuse of human rights in the form of police brutality, and domestic violence [1]. However, contextual factors such as socioeconomic realities and poverty pose a different set of problems for the mitigation and suppression of efforts for COVID-19, especially for vulnerable populations. Eventually, the effects of these interventions pitch down to individual citizens but invariably disproportionately affect vulnerable populations such as street children. This commentary examines the effects of mitigation efforts of COVID-19 on street children who roam the streets of Ugandan cities and whose plight barely gets on the research as well as policy agenda [2]. This paper also draws parallels with similar stories from street children in a few other African countries. According to the Consortium for Street Children (CSC), street children are defined as those who depend on the street with a substantial link to public places for livelihood and work. This population of children and youths is quite dynamic and exact numbers are difficult to establish [3]. It is, therefore, challenging for governments to plan for them. Each child bears a unique story as to why they decide to depend on the street. However, some common reasons include mistreatment at home-34.6%, poverty-25.7%, and the death of parents and guardians-20.6% [2]. Additionally, UNICEF highlights the widespread urbanization which comes with an inflated cost of living outside the realm of affordability for poor families, forcing children to the streets [4]. Street children were first recorded in Uganda in the early 1970s under the existence of a civil war that produced over 800,000 orphans [2]. Despite the fact that Uganda has grown economically and politically, it does not meet the street children´s welfare owing to a lack of government support in the form of budgetary allocations. In comparison, only 0.5% of the street children in Cameroon report having received some form of government support [5]. They also receive aid from well-wishers and NGO´s for example the recent United Nations distribution of 1200 aid kits for street children in Senegal, a country with more than 30000 street children [6,7]. However, such aid is not sustainable and does not adequately meet their needs. These facts reflect how this demographic is often neglected. Below, we discuss some of the responses where street children in Uganda are delineated during the responses to COVID-19. First, whereas the rest of the population in homes access information presented in technological devices such as radios, televisions, phones, and the internet, street children do not have these. Their primary source of information is from street workers who are currently not working [8,9]. Some groups have advocated for printing information that these children could read but this is not on the priority agenda. Street children, therefore, remain uninformed and can be a drawback to the efforts against the continuous spread of the virus. Likewise, documented literacy levels among street children show that 25.5% of them do not have formal education and over 70% have at most elementary school education [4]. This observed low literacy levels is another impediment to the interpretation of the little health information they can access. The children are thus left misinformed and relying on rumors and myths and this has been highlighted in other African countries like Kenya and Ghana [9]. Second, due to the characteristics of their lifestyle, street children often reside in meager accommodation in groups, with no access to clean water, food, or sanitation facilities. These children do not like being on the streets as underscored by a recent interview with a street child in Mombasa, Kenya who revealed that he would rather be arrested during this crisis because there is guaranteed food and shelter in prison [7]. But some street children will avoid incarceration during lockdown enforcement and as they avoid being jailed, they also either spread the disease or increase their own risk of morbidity. Additionally, while it is clear that the WHO mitigation strategies such as staying at home and personal distancing and hygiene are crucial for COVID-19 prevention, this is impractical for street children given the harsh realities they face. Another way in which lockdowns due to COVID-19 has affected street children is to deprive them of their income. Their main economic activity is begging and with lockdowns in place, they risk dying of hunger rather than Coronavirus since the people from whom they beg are all under lockdown and off the streets [7]. Lastly, 50% of street children are exposed to violence including sexual violence on the streets [8]. These rough experiences tend to make them insubordinate and hence likely to remain defiant even when advised about possible ways to avoid the virus. According to Cumber [5], 44.9% of these children have lived on the street for only 7-12 months and 88.2% had no contact with their families. However, the current unpalatable conditions on the street during COVID-19 lockdown with nothing to eat may force them to go back to their abusive families from which they escaped. This may expose them to repeated bouts of violence. On the contrary, more children may get on the streets after lockdowns as poverty and orphanage levels increase following the intentional recessions in the economy and deaths of parents from the virus [7]. There have been positive stories of this pandemic having reunited some street children with their families in the neighboring Kenya courtesy of the philanthropic work of a nun [10]. As encouraging as this sound, no amount of philanthropy could save all the numerous street children in Uganda and the rest of the African continent. The responsibility rests with the governments. Conclusion Measures against COVID-19 have made drastic changes to global public health. However, they have punctuated the problems of low- and middle- income Sub-Saharan African Countries, Uganda inclusive, with already existing vulnerable populations. The limited literature on street children in Uganda emphasizes a need for their important inclusion in policy and research decisions to preserve their lives and wellbeing. This commentary has found paucity in information and research about street children and further research on this topic would bring more conclusions to the true impact of COVID-19 on street children, and thus better considerations. Competing interests The author declares no competing interests.

Acromegaly is a rare disease caused due to hyper secretion of growth hormone. Most of the cases of acromegaly are caused by pituitary adenoma which can be microadenoma or macroadenomas. This condition has a tendency toward overgrowth of the mandible, maxillary widening, tooth separation and skeletal malocclusion which compromises the aesthetics of an individual. Hence dentists have a role in diagnosing this disorder. The aim of this paper is to present a case report of acromegaly.

Adult-onset Still's disease (AOSD) has been recognized as a cause of fevers of unknown origin. Malignancies are the most important differential diagnoses of AOSD which has been rarely reported in association with cancer. The present paper undertakes the study of a 69-year-old Tunisian woman with AOSD according to the diagnostic criteria of Yamaguchi. She was treated by prednisone, then associated with methotrexate. 18 months later, she developed a squamous cell carcinoma treated with chemotherapy and radiotherapy.

Introduction Field Epidemiology Training Programmes (FETPs) are functional ways of strengthening epidemiology, surveillance and outbreak response capacity in countries. However, sustainability of FETPs is a major challenge facing most countries especially in Africa. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) started in 2007 in the University of Ghana School of Public Health as a solution to gaps in the public health workforce. This paper assessed the sustainability strategies embedded in the Ghana Field Epidemiology and Laboratory Training Programme. Methods We assessed the sustainability of GFELTP by document reviews and interviews with programme staff and stakeholders to identify sustainability structures (programme, financial and institutional) that were in place. We grouped information into the following headings: programme structure, institutional, financial and political structures. Results As of July 2017, a total of 350 public health experts have been trained in both frontline and advanced courses since the programme's inception. For funding structures, the programme is funded mainly by its partners and stakeholders who are local government organisations. They provide resources for running of programme activities. Under institutional and political structures, the programme was established as a Ministry of Health/Ghana Health Service programme based in the University of Ghana. The programme steering committee which is currently chaired by the Director Public Health of Ghana Health Service, jointly ensures its implementation. Other structures of sustainability observed were involvement of stakeholders and alumni in human resource of the programme; use of stakeholders as faculty for the programme. These stakeholders include staff from University of Ghana School of Public Health, Ghana Health Service and Veterinary Service Department, World Health Organization and Centers for Disease Control and Prevention. The programme showed evidence of stable sustainability strategies in all four structures evaluated. Conclusion The assessment found the GFELTP to be sustainable. The main factors that contributed to rendering it sustainable were funding, programme, institutional and political structures embedded in the programme. One remarkable sustainability element observed was the strong collaboration that existed between stakeholders of the programme who worked hand in hand to ensure the programme runs smoothly. However, more sources of funding and other essential resources need to be considered to help the programme obtain a pool of resources for carrying out its activities.

Introduction Lessons learned from the Ebola virus disease (EVD) outbreak enabled Liberia to develop a health plan for strengthening public health capacity against potential public health threats. risk communication is one of the core pillars that provide life-saving information and knowledge for the public to take preventive and proactive actions against public health threats. These were applied in response to the post-ebola meningococcal septicemia and meningitis outbreaks in Sinoe and Grand Kru counties. This paper documents risk communication experiences in these post-ebola outbreaks in Liberia. Methods Risk Communication and health promotion strategies were deployed in developing response plans and promptly disseminating key messages to affected communities to mitigate the risks. Other strategies included engagement of community leaders, partnership with the media and dissemination of messages through the community radios, active monitoring community risk perceptions and compliance, rumor management, mobile stage and interpersonal communication (IPC) during the Meningococcal disease outbreaks in Sinoe and Grand Kru counties. Results In Sinoe, about 36,891 households or families in 10 health districts were reached through IPC and dialogue. Circulating rumors such as "Ebola" was the cause of deaths was timely and promptly mitigated. There was increased trust and adherence to health advice including prompt reporting of sick people to the nearest health facility in the two counties. Conclusion Risk communication and health promotion encouraged community support and involvement in any response to public threats and events. No doubt, risk communication and health promotion play an important role in preparedness and response to public health emergencies.

Thyroglossal duct carcinoma is a rare pathologic entity. The surgeon's main concern is whether to perform thyroidectomy or not. In this paper, we report another case of thyroglossal papillary duct carcinoma in a 14-old girl suspected preoperatively and confirmed postoperatively on the histological analysis of resected specimen by a Sistrunk procedure. Therapeutic strategy was completed by a total thyroidectomy with radioactive iodine therapy and suppressive levothyroxine therapy. In the absence of clear guidelines, the management of thyroglossal duct carcinoma is depending on the clinical situation and the experience of the team of surgeons.

Introduction Financing access to healthcare services in developing countries remains a major challenge despite recent advances towards implementation of various health insurance policies in many low and middle-income countries. The use of health insurance is considered an important means to achieve universal health coverage. However, uptake of health insurance in most developing countries remains low as a result of several challenges. Empirical evidence of factors restraining enrolment is rare in many developing countries including Ghana. This paper therefore sought to investigate the factors associated with the uptake of health insurance products and the implications thereof for policy, using Awutu Senya West District of Ghana as case study. Methods A logit model was used to analyze data from 178 respondents randomly selected from two microfinance groups operating in the study area. Results The results indicate that insurance uptake is higher among younger people, but lower among women. Older women are however more likely to take up health insurance compared to older men. In addition, the study reveals that insurance uptake increases with level of education but decreases with household size. Conclusion The study concludes that even though the premium on health insurance coverage in Ghana is arguably low, socio-demographic characteristics such as age, sex, literacy level and household size affect the decision to enroll. Adequate public sensitization on the benefits of the scheme and decreasing the statutory age for exemption from premium payment, especially in rural localities, are some of the measures suggested to enhance health insurance uptake in Ghana and other developing countries.

Healthcare workers (HCWs) are at increased risk of contracting Hepatitis B virus (HBV) infection and other vaccine-preventable diseases, especially if they are not protected by immunity derived from previous infection or vaccination. Sub-Sahara Africa countries including Nigeria is reported to have the highest rate of HBV. Vaccination of HCWs is essential in protecting them from acute and chronic sequelae of HBV or any other form of vaccine-preventable diseases; however, HCWs vaccination remains a challenge for many developing countries including Nigeria due to lack of policy directive on pre-employment screening and vaccination. Poor political will and inadequate funding of healthcare in the country also impacts negatively on the implementation of effective pre-employment screening and vaccination programmes needed to protect HCWs. The aim of this opinion paper is to promote policy direction on pre-employment screening and vaccination in other to protect HCWs from nosocomial HBV infection. The most appropriate time perhaps for promoting the importance of employee immunisation is during pre-employment screening. The policy options are either for employers to allocate financial resources towards HCWs pre-employment screening and vaccination or alternatively initiate a programme where new HCWs provide evidence of protection against HBV or other vaccine-preventable diseases specified in the policy directive. Protecting HCWs form nosocomial HBV infection requires well-articulated policy directive, proper implementation, supported by adequate funding and good political will on the part of employers and government.

INTRODUCTION Communication is key for the successful implementation of polio vaccination campaigns. The purpose of this study is to review and analyse the sources of information utilized by caregivers during polio supplementary immunization activities (SIAs) in Somali, Ethiopia in 2014 and 2015. METHODS Data on sources of information about the polio campaign were collected post campaign from caregivers by trained data collectors as part of house to house independent monitoring. The sources of information analysed in this paper include town criers (via megaphones), health workers, religious leaders, kebele leaders (Kebele is the lowest administrative structure in Ethiopia), radio, television, text message and others. The repetition of these sources of information was analysed across years and zones for trends. Polio vaccination campaign coverage was also reviewed by year and zones within the Somali region in parallel with the major sources of information used in the respective year and zones. 57,745 responses were used for this analysis but the responses were received from < or = 57,745 individuals since some of them may provide more than one response. Moreover, because sampling of households is conducted independently during each round of independent monitoring, the same household may have been included more than once in our analysis. The methodology used for independent monitoring does not allow for the calculation of response rates. Monitors go from house to house until information from 20 households is received. RESULTS From the total 57,745 responses reviewed, over 37% of respondents reported that town criers were their source for information about the 2014 and 2015 polio SIAs. Zonal trends in using town criers as a major source of information in both study years remained consistent except in two zones. 87.5% of zones that reported at least 90% coverage during both study years had utilized town criers as a major source of information while the rest (12.5%) used health workers. CONCLUSION We found that town criers were consistently the major source of information about the polio campaigns for Somali region parents and caregivers during polio immunization days held in 2014 and 2015. Health workers and kebele leaders were also important sources of information about the polio campaign for parents.

Glandular Odontogenic Cyst is a relatively rare cyst of odontogenic origin, which shows glandular or salivary features that are thought to indicate the pluripotentiality of odontogenic epithelium. It is seen in middle-aged adults, and commonly involves the anterior region of the jaws, especially the mandible. It shows non-specific clinico-radiographic findings which may resemble other lesions, but has characteristic histopathologic features which help in its diagnosis. This paper reports an unusual presentation of a glandular odontogenic cyst which was diagnosed in a 64-year old female in the posterior maxilla, along with a literature review of this cyst, especially the cases reported in India in the past.

Adenoid Cystic Carcinoma (ACC) is a rare tumor constitutes for less than 1% of head and neck malignancies and 10% of all salivary gland tumors. Palate is the most common site to be involved in the oral cavity followed by parotid gland and submandibular gland. They are usually asymptomatic, slow growing, characteristically shows infiltrative growth and perineural invasion. This paper reports a case of Adenoid Cystic Carcinoma in a 35 year old female man reported with a swelling on the left side of palate involving the hard and soft palate since 8 months which was diagnosed histopathologically and review of literature of the peculiar clinical, and histopathological features.Pan African Medical Journal 2016; 24

Introduction: Breast cancer is the most common cancer in morocco women were it occupies the first place in term of incidence and mortality. The aim of the present paper is to evaluate the risk factors associated with a breast cancer in a population of Moroccan women. Methods: A casecontrol study was conducted with population women whose age is less than 40 years during 2008-2010 at the National Institute of Oncology of Rabat. These women were interviewed for Epidemiological information and risk factor for breast cancer. Results: Included in this study were 124 cases and 148 age matched controls. No statistically significant case-control difference was found for the early age of menarche (OR = 2.474; CI 95%: 1.354- 4.521), and family antecedents of first degree of breast cancer (OR = 11.556; 95% CI: 2.548-52.411). However physical activity (OR = 0.507; 95% CI: 0.339 -0.757) early maternity age (OR = 0.212; 95% CI: 0.087 - 0.514), multiparity (OR = 0.742; 95% CI: 0.359 -1.539) and breastfeeding than 6 months (OR = 0.739; 95% CI: 0.357 -1.523) appear as significant protective factors. Conclusion: This study show the criminalization of only part of the known risk factors of breast cancer in this age group and confirms the probable protective role of physical activity and factors related to life reproductive women in our study (early childbearing, multiparity and lactation).Pan African Medical Journal 2016; 24

Introduction: Despite the well-known maxim "publish or perish" among academicians, productivity remains low in Nigeria. There are barriers to academic writing which must be identified and addressed. Even after addressing those barriers, authors are faced with another dilemma-where to publish. It was the concern of the authors to evaluate perceived barriers to academic writing and the determinants of journal choice among Nigerian academics. They also attempted to evaluate the determinants of journal choice and perceived barriers to academic writing among Nigerian academicians. Respondents were academicians used in the context of this study to mean anyone involved in academic writing. Such persons must have written and published at least one paper in a peer-reviewed journal in the preceding year to be included in the survey. An online-based self-administered questionnaire. Methods: An online structured and self-administered questionnaire-based cross sectional survey of Nigerian medical academicians was conducted over a period of one year using a Google-powered questionnaire. The questionnaire assessed the determinants of journal choice, perceived barriers to publications, number of publications in the preceding year as a measure of academic productivity and the highest publication fee authors were willing to pay. Results: Of the over 500 email request sent, a total of 200 academicians responded (response rate of 40%). The male and female distribution was 120 and 80 respectively. The highest number of respondents were lecturer 1 and senior lecturers (or junior faculty) (69.5%) however the senior faculty had the higher number of publications in the preceding year. Indexing (35.5%) was the most important determinant of journal choice whilst ease of submission (2.1%) was the least. Unfriendly environment (46%) was the most perceived barrier to publication. Though, majority (88.5%) of the respondents were willing to pay up $300 as publication fees, twice as many junior faculty members (28%) were willing to pay more than $300 as publication fee when compared with professors (12.5%). About 140 of the respondents (70%) were doctors/dentists. Conclusion: In this study, the major determinant of journal choice among Nigerian medics is journal indexing and unfriendly environment appears to be the major perceived barrier to publication. Encouraging a friendly and conducive environment in the universities will impact positively in academic productivity amongst Nigerian faulty members.

This review examines the existing tobacco control research done in the country. It further identifies key gaps present in research and gives recommendations on priority research areas required to implement effective tobacco control programmes. Published literature, technical reports and reports by the Ministry of Health were reviewed. It included studies that measure tobacco use and its effects, monitor progress of tobacco control, or articles that are discussing tobacco control policy. The review was conducted in January 2013 and included 18 papers. There are six studies that assessed the prevalence of current tobacco consumption which yielded prevalence's of between 3.8%-19%. Only one study tried to determine an association between Tobacco use and Health. Studies that monitored progress of legislation indicated that the country lacked coordinated efforts for tobacco control, enforcement was weak and monitoring of the existing tobacco legislation was poor. This review has demonstrated that Kenya has made efforts to generate knowledge on tobacco control through research. However there is lack of research that demonstrates the effects of tobacco consumption on health and studies that detail the impact of the various tobacco control interventions.