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Pulmonary rehabilitation (PR) is an integral part of the management of patients with chronic respiratory diseases. However, there is limited information available on the effectiveness and practice of PR in Africa. This study was conducted to examine the prevalence, structure, and organization of PR in Africa, as well as its substance and claimed efficacy. We conducted a multimethod study involving systematic review of PR studies (obtained from PubMed, Google Scholar, and Cochrane databases) and a web-based survey of African healthcare professionals engaged in PR (using a standardized questionnaire). The review included papers on at least one component of PR in Africa and excluded those on PR from other continents or assessing pulmonary disorders in general without PR, cardio-rehabilitation, or physiotherapy practice in general in Africa. The Cochrane risk of bias and the Newcastle Ottawa scale instruments were used to assess the quality of included studies. We narratively synthesised data across the studies to produce a holistic picture. Of the 14 studies included for qualitative synthesis, seven were randomized controlled trials on the effectiveness of PR treatments with a total number of 333 participants. Of the 39 surveys mailed to health professionals working in Africa, only 14 (35.8%) were returned. We found aerobic exercise and breathing exercises were the most used technique and that quality of life, exercise capacity, and lung function improved significantly after PR treatments. There were differences in the duration, frequency, and length of the programs across the continent. Half of the respondents indicated that their institutions had one or more PR programs for inpatient, outpatient, maintenance, and/or home-based programs. Additionally, aerobic activities, upper and lower extremity strength training were the most frequently used exercise modalities in PR programs, followed by breathing exercises. Pulmonary rehabilitation is understudied in Africa, but it has been linked to improved lung function, exercise capacity, and quality of life. There is a need to invest in techniques tailored to the continent to enhance the implementation of pulmonary rehabilitation in Africa. ispartof: PAN AFRICAN MEDICAL JOURNAL vol:42 ispartof: location:Uganda status: published

Introduction:the COVID-19 pandemic has spread across all countries in Africa, with much of the model forecasting disastrous results owing to weak health services and political uncertainty. In Niger, an adaptive solution to the COVID-19 pandemic has been implemented by community-based surveillance system (CBS) to complement passive case-finding in health systems. Methods:the CBS program was designed to use the current CBS polio network spanning 37 health districts in six regions. Between April and November 2020, 150 community health workers (CHWs) were equipped to improve integrated disease surveillance and response (IDSR) preparedness and response to the COVID-19 pandemic. We retrospectively analysed the health data of the National Health Information System to describe the effect of CBS in COVID-19 surveillance. Results:overall, trained CHWs were able to raise awareness among 2,681,642 persons regarding COVID-19 preventions and controls strategies. They reported 143 (84%) valid alerts resulting in two positive COVID-19 cases missing in the community. In addition, CHWs added to the contact tracing of 37 individuals and informed about the deaths in the community. Conclusion:community-based surveillance improved COVID-19 response in Niger. Logistic assistance and ongoing training are the foundations for increasing and sustaining the sensitivity of CBS systems in response to the COVID-19 pandemic to deter hotspots across countries.

Le défi que pose la pandémie de la COVID-19 sur le système de santé en Afrique est énorme mais pas bien quantifié en ce jour. Nous avons évalué les conséquences de la COVID-19 sur les activités curatives et préventives des formations sanitaires sur une période de six mois au niveau de 17 centres de sante intégré au Niamey de manière en comparant la première moitié de l´année 2020 à celle de l´année 2019. Les différences furent plus prononcées au deuxième trimestre 2020, avec une réduction de 34% (95%IC: -47% à -21%) pour les soins curatifs, 61% (95%IC: -74% à -48%) pour la vaccination aux pentavalents 1 et 3 et de 36% (95%IC: -49% à -23%) pour la VAR 1. Un gain quasi nul de 1% (95%IC: -2% à 4%) fut noté pour la fréquentation à la consultation prénatale annulant ainsi les acquis du premier trimestre. La pandémie de la COVID-19 impacte négativement sur les prestations de service destinées aux groupes les plus à risques de la population à savoir les femmes et les enfants. Des nouvelles stratégies comme l´engagement communautaire sont urgentes.

The implementation of electronic data collection during supportive supervision visits (ISS) using the Open Data Kits (ODK) Collection in Niger has provided a factual basis for monitoring the performance of the Polio eradication program (PEP) and the immunization program. With the notification of the first case of COVID-19 on 19 March 2020, there was a rapid need for quality knowledge to monitor the pandemic. For the first time in Niger, we initiated a six-month (May to October 2020) joint ISS-COVID-19 surveillance program to improve and monitor healthcare workers' performance to efficiently investigate COVID-19 cases in eight provinces. Overall, 1,378 ISS visits were performed through 390 health facilities, during which 4,638 health workers were trained and 527,151 medical records were reviewed, of which 28 suspected cases of COVID-19 were found. Field visits for contact tracing in their communities were accomplished and closed monitoring ensured until full recovery. Building on the tradition of PEP, a problem-solving process, feedback and on-the-job training on COVID-19 surveillance is set to enhance notification in the coming weeks and months. This is facilitated by accurate use of ODK Collect for real-time data surveillance successfully implemented. Other topics in the briefing included fundamentals of infection prevention and control for COVID-19 for both health professionals and community leaders. From this experience, the ISS has emerged as a key component of COVID-19 surveillance, especially in regions with a fragile health system. Our observation is a step forward for pragmatic interventional studies.

BACKGROUND The extraction and processing of copper and cobalt in the African Copperbelt in the Democratic Republic of Congo have led to substantial environmental pollution, causing concerns about possible adverse effects on human health, including birth defects. CASES We report three neonates with clinically diagnosed holoprosencephaly who were part of a case-control study performed in Lubumbashi between February 2013 and February 2015. One mother had a high concentration of uranium in urine, and high manganese concentrations were found in blood of another mother and in cord blood of one infant. Two of the three fathers had a mining-related job. DISCUSSION We hypothesize that these cases of holoprosencephaly were connected to mining-related pollution, possibly via epigenetic alterations induced by paternal occupational exposure to toxic metals.

We determined the prevalence of respiratory symptoms, pulmonary function and urinary metals among artisanal stone-crushers. We conducted a cross-sectional study of 48 male artisanal stone-crushers and 50 male taxi-drivers using a standardised questionnaire and spirometry. Concentrations of trace metals were measured by inductively coupled plasma - mass spectrometry (ICP-MS) in urine spot samples. Mean (±SD) age was 34±9 years. Wheezing was more prevalent among stone-crushers (22.9%) than among taxi-drivers (6.0%, p˂0.0021), but stone crushers had higher percent predicted FEV1 (104±4 vs 89±4, p=0.019) and MEF25 (88.0±9 vs 56±9, p=0.021) than taxi-drivers. Overall, young age was inversely associated with wheezing (aOR 0.85, 95% CI 0.67-0.88), cough (aOR 0.86, 95% CI 0.75-0.97) and shortness of breath (aOR 0.76, 95% CI 0.59-0.94); dry season was associated with runny nose (aOR 8.71 95% CI 2.32-31.32) and sneezing (aOR 8.60, 95% CI 2.33-31.74). Consumption of local well water was associated with wheezing (aOR 6.62 95% CI 1.44-30.34) and sneezing (aOR 4.06, 95% CI 1.18-14.23). The job of stone-crusher was inversely associated with itchy eyes (aOR 0.11, 95% CI 0.015-0.92) and runny nose (aOR 0.17, 95% CI 0.03-0.89). Participants exhibited higher urinary levels of trace metals than reference values from industrially developed countries. Urinary Co, Ni, As, Se and U were higher in stone-crushers than in taxi-drivers. Although stone-crushers were more heavily exposed to mineral dust than taxi-drivers, as evidenced from their higher urinary concentrations of dust-related trace metals, they did not appear to have more respiratory impairment than taxi-drivers.