Alliance for International Medical Action

No abstract available.

BackgroundIn line with the Integrated Management of Childhood Illness (IMCI) guidelines, healthcare workers (HCWs) should refer all severe pneumonia among children under 5 seen in primary care in resource-limited settings. We investigated the frequency and correlates of missed opportunities for hospital referral (MOHR) of clinical severe pneumonia. Our study was embedded within the Améliorer l'Identification des détresses Respiratoires chez l'Enfant project, which involved the routine implementation of pulse oximetry (PO) within IMCI consultations at primary healthcare centres (PHCs) in West Africa: Burkina Faso, Guinea, Mali and Niger.MethodsAll children aged 2–59 months attending IMCI consultations in 16 PHCs and classified as severe cases using IMCI+PO were enrolled into a prospective cohort for 14 days, with parental consent. We estimated the rate of MOHR for IMCI-defined severe pneumonia, which was either not referred, or referred but did not make it to hospital. Correlates of MOHR at day 14 were investigated using logistic mixed regression with random effect for PHCs.ResultsFrom June 2021 to June 2022, among the 1786 children aged 2–59 months classified as severe cases by IMCI+PO, 682 (38.2%) were severe pneumonia. Of these, 35 (5.1%) also had severe anaemia, 47 (6.9%) severe hypoxaemia (SpO2 <90%) and 602 (88.3%) severe malaria. HCW made the referral decision for 125 (18.3%) children, refused by three (2.4%) families; 560 (82.1%) were MOHR. Severe anaemia reduced the odds of MOHR (adjusted OR (aOR): 0.02; 95% CI 0.01 to 0.07) whereas having an SpO2 between 90% and 93% (aOR: 12.16; 95% CI 3.47 to 42.61) or greater than 94% (aOR: 11.81; 95% CI 3.98 to 35.02) or severe malaria (aOR:2.55; 95% CI 1.04 to 6.26) significantly increased it.ConclusionMOHR for severe pneumonia was extremely high at PHC level in these settings, mainly explained by HCW’s decisions. Strengthening the referral system and training HCW to reinforce their adherence to IMCI guidelines remains essential to improve the management of severe pneumonia.Trial registration numberPACTR202206525204526; Pan African Clinical Trials Registry on 15 June 2022.

Introduction: Lassa fever (LF) is endemic in Nigeria, with Ondo and Edo States serving as epicenters of recent outbreaks. The INTEGRATE clinical trial seeks to identify effective treatments for LF. However, trial participation could be hindered by community sociocultural beliefs, misconceptions, or mistrust. This study explored community knowledge, attitudes, and perceptions surrounding LF and clinical trials in Ondo and Edo States, to inform the design and implementation of a culturally responsive community sensitisation strategy to promote acceptability and participation in the clinical trial. Methods: An exploratory mixed methods design was employed across selected communities in both States, engaging 150 purposive sampled community leaders and members. Quantitative data were first collected using a structured questionnaire and analyzed descriptively with SPSS and R software. Qualitative insights were then gathered from a subset of participants to explore sensitive issues through semi structured interviews, and thematically analyzed using MaxQDA. Findings were interpreted within each state’s sociocultural context to ensure their relevance. Results: Participants generally demonstrated good knowledge of Lassa fever (LF); 91% identified eating food contaminated with rat excreta as a risk factor. However, 13%attributed LF to witchcraft and 11% to divine punishment. Belief in spiritual and traditional cures coexisted with confidence in biomedical treatments. Willingness to participate in LF clinical trials was driven by the promise of quality, free care. Some also viewed participation as a way to serve their community. However, concerns around the clinical trial process—such as randomisation, efficacy, and safety—were key barriers. Notably, 77.3%would only participate if clearly informed, and 36% required family approval. Conclusion: These findings highlight the need for context-sensitive communication strategies that address spiritual beliefs, clarify clinical trial processes, and build trust in biomedical care. Tailored sensitisation could dispel misconceptions and enhance trial acceptability, supporting LF treatment advancement in Nigeria and beyond.

Despite being the most common cardiovascular risk factor, the actual burden of hypertension is poorly characterized in Africa. We meta-analysed the most extensive pooled data to determine the overall prevalence of hypertension in Africa. Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically searched Google Scholar, PubMed, ScienceDirect, and Web of Science databases to retrieve prevalence studies only on hypertension among Africans published between 2002 and 2023. Furthermore, we meta-analysed the crude and age-adjusted prevalences of hypertension using a random effect model due to the expected high heterogeneity, with logit transformation of the original proportions. Seventy-eight (out of an initial 779 screened) articles with complete data were included, with a total number of hypertension cases of 71 004 and a denominator population of 286 575, mostly from community-based studies in 23 countries. The pooled crude prevalence of hypertension was 28.5/100 persons [95% confidence interval (CI): 25.3–31.8%] and a 95% prediction interval of 7.6–65.6%; the pooled prevalence increased with age and was highest among the aged ≥75 years: 51.4% (95% CI: 42.0–60.6%) and remained highest in the Southern Africa region overall (34.8%) and in the last decade (2013–23; 44.5%). The point estimate of the pooled crude prevalence was higher among urban dwellers, 32.9% (95% CI: 26.8–39.5%), than rural residents, 26.3% (95% CI: 20.4–33.3%). In a subset of 21 articles reporting age stratification consistent with the World Health Organization standard population, the pooled age-standardized prevalence was 27.2/100 persons (95% CI: 20.9–33.6%). The burden of hypertension remains high, especially in urban areas and with increasing age. Frequent screening and treatment are recommended, especially in urban areas.

AbstracBackgrounThe hyperdense middle cerebral artery sign refers to an appearance of increase attenuation of the proximal (MCA) that is often associated with thrombosis of the M1 MCA segment and may be the only diagnostic feature on computed tomography early after ischemic stroke.To evaluate the CT density number of hyperdense MCA presented with hyperacute and acute stroke and comparing the measurements with those of non-stroke patients with hyperdense MCA on the baseline non-enhanced brain CT. MethodsThis study is comparison cross sectional study included two groups; group A: patients aged &ge;35 years with clinical diagnosis of hyperacute (first 6 hours) or acute (6 hours-4 days) stroke who were referred to the CT unit and group (B) patients aged &ge;35 years referred to the CT unit for various indication with no clinical evidence of stroke who were labeled by two radiologists as normal brain CT. ResultsThis study showed there is a statistically significant difference between the mean density of the dense MCA at the site of stroke (48 HU) when compared tothecontralateral MCA (39.7 HU) with average difference in density value of 8.3 HU (p&lt;0.001), the same applies when tested against the dense MCAS in the non-stroke group (42.2 HU) with average difference of 5.8 HU (p&lt;0.002). However, no significant difference was found when testing the density in the non-stroke group against that of the contralateral MCAS in stroke group (p=0.2). Moreover, significant variation was observed between the density ratio of stroke and non-stroke patients (1.29 vs 1.02, p=0.009). A cutoff MCA density of 41.7 HU was proposed to the predict pathological state.ConclusionHyperdense MCA is associated with acute ischemic stroke exhibit higher CT attenuation value that of contralateral normal vessel or dense MCAS in healthy individuals. A CT density value of &gt;41.7 HU is suggested as the best limit to mark the distinction.

Background: Patient education is a core component of cardiac rehabilitation program and a part of the consensus statement for Cardiac rehabilitation delivery model for low resource settings. To our knowledge, there is little to no evidence regarding cardiac patient education implementation in sub–Saharan Africa, despite all the benefits and the urgent need for prevention in our settings. Purpose: To describe a patient education (PE) pilot project named “the Heart School” at Cheikh Anta Diop University of Dakar. Methods: In this cross sectional study were included 45 patients addressed for a patient education program. Patient education was delivered on weekly one-on-one sessions. Content of the educational program is shown in figure 1. Progression was assessed through self-evaluation scales with scores ranging from 0 to 10 administered before and after the program. Data analysis was performed with SPSS version 18 with a level of significance set at p&lt;0.05. Results:: Coronary artery disease was the primary indication in 87% of cases. At the end of the program, there was a significant improvement in knowledge of the disease (4.5 vs. 7.4; p &lt;0.001) and its treatment (4.7 vs. 6.8; p &lt;0.001), as well as good practices of physical activity (4.5 vs. 7; p &lt;0.001), cardioprotective diet (4.2 vs. 7; p &lt;0.001) and motivation to change lifestyle (5.6 vs. 7.8; p &lt;0.001). Conclusion: Results from this pilot project were promising. However long-term follow up is necessary to better assess the sustainability of these results.

BackgroundLassa fever (LF) is a severe re-emerging infectious disease caused by the Lassa virus (LV). LF is a priority disease on the World Health Organization’s R&D blueprint and affects a large number of countries in West Africa, with Nigeria carrying the highest case burden in the world. Current treatment options are limited to supportive care and the antiviral drug ribavirin. However, evidence for the efficacy of ribavirin in LF is poor. A recent study showed that in vivo plasma concentrations do not suffice to exert a relevant antiviral effect. New drugs for LF treatment are therefore urgently needed but no therapeutic trials have been conducted for this indication in the past decades. Favipiravir is a broad-spectrum antiviral registered for pandemic influenza that has also been clinically evaluated for other viral infections. It shows potent activity against LV in pre-clinical studies. To evaluate the safety and tolerability of favipiravir as repurposed drug in the treatment of LF, a phase II clinical trial was conducted. MethodsLF patients were recruited at the Irrua Specialist Teaching Hospital and the Federal Medical Centre of Owo in Nigeria, which are the worldwide largest LF treatment centres. Blood sampling for virological, serological and immunological analyses, hematology and biochemistry as well as clinical assessments were done on days 1, 2, and then every other day until the end of the study.ResultsIn total, 40 LF patients were included in the trial between 2021 and 2022. Results on cure rates, safety and tolerability of this first GCP compliant phase II clinical trial will be presented to provide first insights into this new treatment option for LF.

Nearly 90% of farming households in Senegal rely on rainfed agriculture; in recent years, climate change-induced disruptions to rainfall patterns and the ensuing depletion of water resources have had adverse effects on agricultural production, livelihoods, and food security. Recent studies recommend further assessment of the viability of and potential for Flood Residual Water Cultivation (FRWC) as an alternative growing strategy (i.e., to supplement or extend natural growing seasons). This study utilizes satellite imagery, GIS mapping, and crop analysis to identify areas with high potential for FRWC in Senegal's Sédhiou and Tambacounda regions, and recommends key crops that can be grown using FRWC and support food security. By calculating the Normalized Difference Water Index (NDWI) values based on historical data for the rainy season (September) and the first dry month after the rainy season (November) over a 9-year period, areas with flooding potential were identified and mapped. To assess the crop-growing potential for these mapped areas, we used crop reference evapotranspiration (ET) and determined daily water requirements for the select crops included in our analyses. indicated suitable FRWC areas along river valleys in both regions, with specific locations identified along the Gambia River, the Senegal River in the Bakel Department, and low-lying plains near Kidira and Gourel Bouri. It was observed that regions closer to the Sahara Desert required more water for crop production due to higher temperatures and evapotranspiration rates. Our study identified a total potential FRWC area of 20.7 km² and recommends short-duration crops like okra, French beans, and drought-tolerant crops such as sorghum for FRWC. The integration of FRWC with climate-smart management practices can aid in climate adaptation and economic empowerment in the studied regions, and in Sub-Saharan Africa at large.