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BackgroundZambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training nonphysician clinical students in Zambia because of the shortage of qualified medical lecturers and learning resources at training sites. To address this shortage and strengthen the MLP program, a self-directed electronic health (eHealth) platform was introduced, comprising technology-supported learning (e-learning) for medical education and support for health care practice. MLP students were provided with tablets that were preloaded with content for offline access. ObjectiveThis study aimed to explore MLP students’ and medical lecturers’ perceptions of the self-directed eHealth platform with an offline-based tablet as a training and health care practice support tool during the first year of full implementation. MethodsWe conducted in-depth qualitative interviews with 8 MLP students and 5 lecturers and 2 focus group discussions with 16 students to gain insights on perceptions of the usefulness, ease of use, and adequacy of self-directed e-learning and health care practice support accessible through the offline-based tablet. Participants were purposively sampled. Verbatim transcripts were analyzed following hypothesis coding. ResultsThe eHealth platform (e-platform), comprising e-learning for medical education and health care practice support, was positively received by students and medical lecturers and was seen as a step toward modernizing the MLP program. Tablets enabled equal access to offline learning contents, thus bridging the gap of slow or no internet connections. The study results indicated that the e-platform appears adequate to strengthen medical education within this low-resource setting. However, student self-reported usage was low, and medical lecturer usage was even lower. One stated reason was the lack of training in tablet usage and another was the quality of the tablets. The mediocre quality and quantity of most e-learning contents were perceived as a primary concern as materials were reported to be outdated, missing multimedia features, and addressing only part of the curriculum. Medical lecturers were noted to have little commitment to updating or creating new learning materials. Suggestions for improving the e-platform were given. ConclusionsTo address identified major challenges, we plan to (1) introduce half-day training sessions at the beginning of each study year to better prepare users for tablet usage, (2) further update and expand e-learning content by fostering collaborations with MLP program stakeholders and nominating an e-platform coordinator, (3) set up an e-platform steering committee including medical lecturers, (4) incorporate e-learning and e-based health care practice support across the curriculum, as well as (5) implement processes to promote user-generated content. With these measures, we aim to sustainably strengthen the MLP program by implementing the tablet-based e-platform as a serious learning technology for medical education and health care practice support.

Background: Malaria in pregnancy remains a major public health problem in endemic countries, especially in sub-Saharan Africa (SSA). Existing interventions such as intermittent preventive therapy in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) are effective against placental malaria. However, low uptake of this intervention is a challenge in SSA. This study assessed factors affecting IPTp-SP uptake among pregnant women as well as their health care providers, including health system-related factors. Methods: From November 2018 until May 2019 a mixed-methods study was conducted in one urban and one rural district of the Upper West Region of Ghana. A multi-stage sampling technique was used to recruit 740 3rd trimester pregnant women and 74 health service providers from 37 antenatal care (ANC) facilities. Quantitative data was collected through a standard questionnaire from pregnant women and ANC service providers. Three focus group discussions (FGDs) were conducted in each district with pregnant women who had defaulted on their IPTp doses to collect information about the challenges in accessing IPTp-SP. The primary outcome was the uptake of IPTp-SP during antenatal care visits. In addition, the health care provider and health system-related factors on the administration of SP were assessed, as well as details of folic acid (FA) supplementation. Data were analysed using descriptive statistics and Poisson regression. Results: Responses from 697 pregnant women were analysed. Of these, 184 (26.4%) had taken the third dose of SP (SP3) in line with international guidelines. IPTp-SP uptake was low and significantly associated with the number of maternal ANC contacts and their gestational age at 1st ANC contact. Most pregnant women were regularly co-administered SP together with 5 mg of FA, in contrast to the international recommendations of 0.4 mg FA. The main challenges to IPTp-SP uptake were missed ANC contacts, knowledge deficiencies among pregnant women of the importance of IPTp, and frequent drug stock outs, which was confirmed both from the ANC providers as well as from the pregnant women. Further challenges reported were provider negligence/absenteeism, adverse drug reactions, and mobile residency of pregnant women. Conclusions: The uptake of IPTp-SP in the study area is still very low, which is partly explained by frequent drug stock outs at health facilities, staff absenteeism, knowledge deficiencies among pregnant women, and missed ANC contacts. The high dosing of co-administered FA is against international recommendations. These observations need to be addressed by the national public health authorities.

Objective To investigate if the first national insecticide-treated bed-net campaign in Burkina Faso, done in 2010, was followed by a decrease in childhood malaria in a district with high baseline transmission of the disease. Methods We obtained data on the prevalence of Plasmodium falciparum parasitaemia in children aged 2 weeks to 36 months from malaria surveys in 2009 and 2011. We assessed morbidity in children younger than 5 years by comparing data from the Nouna health district's health management information system before and after the campaign in 2010. We analysed mortality data from 2008 to 2012 from Nouna's health and demographic surveillance system. Findings The bed-net campaign was associated with an increase in the reported use of insecticide-treated nets. In 2009,73% (630/869) of children reportedly slept under nets. In 2011, 92% (449/487) did. The campaign had no effect on the proportion of young children with P. falciparum parasitaemia after the rainy season; 52% (442/858) in 2009 and 53% (263/499) in 2011. Cases of malaria increased markedly after the campaign, as did the number of children presenting with other diseases. The campaign was not associated with any changes in child mortality. Conclusion The 2010 insecticide-treated net campaign in Burkina Faso was not associated with a decrease in care-seeking for malaria or all-cause mortality in children younger than 5 years. The most likely explanation is the high coverage of nets in the study area before the campaign which could have had an effect on mosquito vectors, limiting the campaign's impact. [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Etudier si la premiere campagne nationale visant a utiliser des moustiquaires impregnees d'insecticide au Burkina Faso, menee en 2010, a ete suivie d'une baisse des cas de paludisme infantile dans un district ayant un taux eleve de transmission de la maladie. Methodes Nous nous sommes procure des donnees sur la prevalence de la parasitemie de Plasmodium falciparum chez les enfants ages de 2 semaines a 36 mois a partir des enquetes sur le paludisme menees en 2009 et 2011. Nous avons evalue la morbidite chez les enfants de moins de 5 ans en comparant les donnees du systeme d'information sanitaire du district de Nouna avant et apres la campagne de 2010. Nous avons analyse les donnees sur la mortalite de 2008 a 2012 provenant du systeme de surveillance sanitaire et demographique de Nouna. Resultats La campagne pour l'utilisation de moustiquaires a ete associee a une augmentation de l'utilisation de moustiquaires impregnees d'insecticide. En 2009, d'apres l'enquete menee, 73% des enfants (630/869) dormaient sous une moustiquaire. En 2011, ils etaient 92% (449/487). La campagne n'a pas eu d'effet sur la proportion de jeunes enfants presentant une parasitemie de P falciparum apres la saison des pluies: ils etaient 52% (442/858) en 2009 et 53% (263/499) en 2011. Les cas de paludisme ont sensiblement augmente apres la campagne, comme le nombre d'enfants atteints d'autres maladies. La campagne n'etait associee a aucun changement de la mortalite infantile. Conclusion La campagne de 2010 pour l'utilisation de moustiquaires impregnees d'insecticide au Burkina Faso n'a pas ete associee a une diminution des consultations pour paludisme ou de la mortalite, toutes causes confondues, chez les enfants de moins de 5 ans. L'explication la plus probable est liee au taux eleve d'utilisation de moustiquaires dans la zone etudiee avant la campagne, qui pourrait avoir eu un effet sur les moustiques vecteurs de la maladie et avoir limite l'impact de la campagne. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Investigar si la primera campana nacional de mosquiteros tratados con insecticida en Burkina Faso, que se llevo a cabo en 2010, tuvo como resultado un descenso del paludismo infantil en un distrito con una referencia elevada de transmision de la enfermedad. Metodos Se obtuvieron datos sobre la prevalencia de parasitemia por Plasmodium falciparum en ninos de edad entre las 2 semanas y los 36 meses de encuestas sobre la malaria de 2009 y 2011. Se evaluo la morbilidad en ninos menores de 5 anos mediante la comparacion de los datos del sistema de gestion de Informacion sanitaria del departamento de salud de Nouna antes y despues de la campana de 2010. Se analizaron los datos de mortalidad desde 2008 hasta 2012 del sistema de vigilancia sanitaria y demografica de Nouna. Resultados La campana de distribucion de mosquiteros se relaciono con un aparente aumento del uso de redes tratadas con insecticida. En 2009, aparentemente el 73% (630/869) de los ninos dormia bajo mosquiteros. En 2011, lo hacia el 92% (449/487). La campana no tuvo efecto en la proporcion de ninos pequenos con parasitemia por R falciparum despues de la temporada de lluvias; el 52% (442/858) en 2009 y el 53% (263/499) en 2011. Los casos de malaria aumentaron notablemente despues de la campana, igual que lo hizo el numero de ninos que mostraban otras enfermedades. La campana no se relaciono con ningun cambio en la mortalidad Infantil. Conclusion La campana de distribucion de mosquiteros tratados con Insecticida realizada en 2010 en Burkina Faso no estuvo relacionada con un descenso en la atencion medica relacionada con la malaria o la mortalidad a causa de la misma en ninos menores de 5 anos. La explicacion mas logica es la gran cobertura de redes en el area del estudio antes de la campana, lo que podria haber tenido un efecto en los mosquitos vectores, limitando el impacto de la campana., Introduction Malaria remains a major threat to the health of some three billion people in 108 countries where the disease is endemic. (1) According to the World Health Organization (WHO), [...]

Aim: For over 15 years, the pharmaceutical industry has been engaged in developing medicines for children to comply with the European Union (EU) and the United States (US) regulatory requirements. We assessed the authorization availability of these medicines in countries without paediatric regulatory obligations. Special attention was given to the authorization availability of paediatric formulations. Methods: Medicines for children were sampled from the US Food and Drug Administration and European Medicines Agency websites. We carried out systematic content analysis of product information and compared paediatric labelling in Australia, Brazil, Canada, Russia and South Africa with the EU or the US. The authorization availability of paediatric formulations in originator and generic medicines was reviewed. In Kenya, the authorization availability of sampled medicines and paediatric formulations was investigated. Results: A total of 161 medicines authorized in the EU or the US were sampled. Whilst at least one paediatric indication was found in 70% of the medicines, the EU and US level of authorization was on average 38% in Australia, Brazil, Canada, Russia and South Africa. Paediatric formulations were authorized on average for 40% of originator and 36% of generic medicines. Kenya had the lowest authorization availability of medicines (40%) and formulations (26%). Conclusions: The authorization availability of novel medicines for children is lower in countries without paediatric regulatory obligations. Paediatric formulations often do not reach other countries if left unregulated, and their generic uptake is low. To increase authorization availability, submission of paediatric development results should become obligatory in each jurisdiction. Policy initiatives to stimulate the introduction of developed formulations should be encouraged. [ABSTRACT FROM AUTHOR]