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Sickle cell disease (SCD) results in chronic hemolytic anemia, recurrent vascular occlusion, insidious vital organ deterioration, early mortality, and diminished quality of life. Life-threatening acute physiologic crises may occur on a background of progressive diminishing vital organ function. Sickle hemoglobin polymerizes in the deoxygenated state, resulting in erythrocyte membrane deformation, vascular occlusion, and hemolysis. Vascular occlusion and increased blood viscosity results in functional asplenia and immune deficiency in early childhood, resulting in life-long increased susceptibility to serious bacterial infections. Infection remains a main cause of overall mortality in patients with SCD in low- and middle-income countries due to increased exposure to pathogens, increased co-morbidities such as malnutrition, lower vaccination rates, and diminished access to definitive care, including antibiotics and blood. Thus, the greatest gains in preventing infection-associated mortality can be achieved by addressing these factors for SCD patients in austere environments. In contrast, in high-income countries, perinatal diagnosis of SCD, antimicrobial prophylaxis, vaccination, aggressive use of antibiotics for febrile episodes, and the availability of contemporary critical care resources have resulted in a significant reduction in deaths from infection; however, chronic organ injury is problematic. All clinicians, regardless of their discipline, who assume the care of SCD patients must understand the importance of infectious disease as a contributor to death and disability. In this concise narrative review, we summarize the data that describes the importance of infectious diseases as a contributor to death and disability in SCD and discuss pathophysiology, prevalent organisms, prevention, management of acute episodes of critical illness, and ongoing care.

Abstract Background Stronger health systems, with an emphasis on community-based primary health care, are required to help accelerate the pace of ending preventable maternal and child deaths as well as contribute to the achievement of the Sustainable Development Goals (SDGs). The success of the SDGs will require unprecedented coordination across sectors, including partnerships between public, private, and non-governmental organizations (NGOs). To date, little attention has been paid to the distinct ways in which NGOs (both international and local) can partner with existing national government health systems to institutionalize community health strategies. Discussion In this paper, we propose a new conceptual framework that depicts three primary pathways through which NGOs can contribute to the institutionalization of community-focused maternal, newborn, and child health (MNCH) strategies to strengthen health systems at the district, national or global level. To illustrate the practical application of these three pathways, we present six illustrative cases from multiple NGOs and discuss the primary drivers of institutional change. In the first pathway, “learning for leverage,” NGOs demonstrate the effectiveness of new innovations that can stimulate changes in the health system through adaptation of research into policy and practice. In the second pathway, “thought leadership,” NGOs disseminate lessons learned to public and private partners through training, information sharing and collaborative learning. In the third pathway, “joint venturing,” NGOs work in partnership with the government health system to demonstrate the efficacy of a project and use their collective voice to help guide decision-makers. In addition to these pathways, we present six key drivers that are critical for successful institutionalization: strategic responsiveness to national health priorities, partnership with policymakers and other stakeholders, community ownership and involvement, monitoring and use of data, diversification of financial resources, and longevity of efforts. Conclusion With additional research, we propose that this framework can contribute to program planning and policy making of donors, governments, and the NGO community in the institutionalization of community health strategies.

Abstract Introduction The resource is designed to familiarize medical students with the special needs and issues of the adolescent patient, including specific components of the adolescent expanded social history. The session emphasizes a combination of didactic and experiential learning and is broken into two parts. Methods The first section consists of a 1-hour didactic lecture discussing the needs of the adolescent patient, the importance of addressing the health needs of adolescents, and important procedural items such as assuring confidentiality and a level of autonomy. Following the lecture, the students report to the clinical skills assessment program section for their standardized patient interaction. Student pairs interview an adolescent using the structured communication adolescent guide. One student is responsible for conducting the interview (20 minutes) while the second student is responsible for observing the interaction and giving feedback along with the adolescent patient instructor (out of character) at the end of the session (10 minutes). The second student can then be the primary interviewer if there are enough adolescent instructors/time available. The encounters are observed by faculty via remote video and there is time set aside for students to debrief with faculty at the end of the session in a small-group setting. Students have a 1-hour didactic lecture discussing the needs of the adolescent patient. Results Students and faculty were surveyed on a quarterly basis in order to facilitate curriculum development. The curricular pieces are graded from poor to excellent based on three criteria, (1) relevance of topic, (2) quality of material presented, and (3) quality of the presentation. Both students and faculty graded the session favorably. Ninety-two percent of students rated the relevance of the lecture as good to excellent. Ninety percent thought the quality of the material is good to excellent, and 87% rated the quality of the presentation as good to excellent. Students also thought highly of the clinical skills section. Ninety percent thought the session increased their understanding and improved their self-assessment skills, and 80% thought the quality of feedback was good to excellent. Discussion A stable pool of recruited adolescents is ideal. Possibilities include outreach to enrichment programs in local high schools or volunteer groups. It is strongly recommend recruiting more students than necessary to anticipate potential absences. Another item to consider is the key importance of preparing the adolescent to feel comfortable to give feedback.