Global Health Systems Solutions

Introduction: The fight against cervical cancer stumbles against resistance to accepting vaccines. Vaccination hesitancy is a worldwide phenomenon. It seems this phenomenon is more amplified in Africa. With the advent of COVID 19, many conspiracy theories against all the vaccines have emanated from various quarters. Vaccination against Human Papilloma Virus is no exception to the current dynamics. A study on this topic was carried out in the Fako Division-Cameroon. Structural and individual reasons could explain vaccination hesitancy.
 Objective: The objective of this study is to attempt an explanation of why vaccination hesitancy has to do with poor uptake of cervical cancer vaccines.
 Methodology: a community-based cross-sectional study was carried out in some towns of the Fako Division – Cameroon from 5 to January 20, 2021. Paper-based questionnaires were administered only to those who consented to participate in this study. And chi-square test was estimated to establish the association between participant socioeconomic characteristics and cervical cancer vaccine hesitancy
 Results: A total of 250 consecutively enrolled participants were included in the study. Women with a high level of education will readily accept vaccination against cervical cancer. About 71% of our sample does not trust government decisions regarding judgments against cervical cancer. If given a choice between medical treatment and prayers, 62% of our studied population will prefer prayers. There is some degree of bias against female children in our community.
 Conclusion: Many components constitute vaccination hesitancy. The corruption of political elites, brainwashing of masses by the new type of churches, self-convictions, ignorance, lack of knowledge on CC, and gender bias are some. They all increase on structural causes: the colonial background and the low socioeconomic status of these countries.

Abstract Background: Programs that integrated tuberculosis (TB) and Human Immunodeficiency Virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs.Methods: A systematic review of evidence from published observational and interventional studies will be performed. The evidence will be obtained by searching Medline, Embase, and Global Health electronic databases with date limits being March 2004 and December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using appropriate quality assessment tools. Analysis and synthesis of data on TB treatment outcomes will be performed using random-effects meta-analysis on STATA-15 software. Data on predictors of TB treatment outcomes will be analysed using thematic analysis and synthesised using a descriptive approach and where appropriate, random-effects meta-analysis will be performed to obtain pooled effect sizes. The confidence in cumulative quantitative and qualitative evidence will be assessed using the appropriate versions of the Grading of Recommendations, Assessment, Development and Evaluation approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal.Discussion: This study is expected to highlight the quality of integrated TB/HIV treatment programs and their potential to uphold successful MDR-TB treatment outcomes. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs.Systematic review registration: This review has been submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO)

Background: Self-medication is an important public health problem in developed and developing countries, with antimicrobial resistance increasing over time as a result of antimicrobial abuse. The aim of this study was to determine the prevalence of antimicrobial self-medication as well as associated factors among outpatient consultations of two hospitals within the Buea Health District, Cameroon. Methods: This was a cross-sectional survey that was conducted in two hospitals in the Buea Health district from June to October 2018. 329 patients for outpatient consultations were selected by simple random sampling and interviewed. The data was analyzed using SPSS software version 21. Descriptive statistics such as frequencies, percentages was used to present data. Chi square test was applied to compare various variables of those who practiced self-medication and those who did not practice in order to find the statistical significance. Multivariate logistic regression analysis was used to determine factors associated with self-medication.

IntroductionIdentifying White Coat Hypertension (WCH) may avoid inappropriate commitment of individuals to lifelong and costly blood pressure (BP) lowering medications’. We assessed the prevalence and determinants of WCH in urban clinical settings in Cameroon.MethodsParticipants were a consecutive sample of adults, who underwent ambulatory BP measurements (ABPM) for the diagnosis of hypertension and evaluation of treatmentin three referral cardiac clinics in the cities of Yaounde and Douala, between January 2006 and July 2011. WCH was defined as an office-based systolic (or diastolic) BP ≥ 140(90) mmHg together with an average day time ambulatory systolic (and diastolic) BP < 135(85) mmHg.ResultsOf the 500 participants included, 188 (37.6%) were women, 230 (46%) were nonsmokers and 53 (10.6%) had diabetes mellitus. The mean age was 51.6±10.2years. The ABPM readings were higher in men than in women (p<0.05).The prevalence of WCH was 26.4% overall, 39.3% in women and22.4% in men (p=0.01).In multivariable analysis, body mass index was the only significant determinant of WCH (Odds ratio= 1.15(95% confidence intervals: 1.00-1.43), p<0.05).ConclusionThe prevalence of WCH was high in our study population and was correlated only with BMI. Accurate measurement of BP and appropriate diagnosis of hypertension using ABPM in this setting may help limiting the consequences of over estimating hypertension severity on individuals, families and health systems.

BackgroundThe Strengthening Laboratory Management Toward Accreditation (SLMTA) programme is designed to build institutional capacity to help strengthen the tiered laboratory system. Most countries implement the SLMTA three-workshop series using a centralised model, whereby participants from several laboratories travel to one location to be trained together.ObjectivesWe assessed the effectiveness and cost of conducting SLMTA training in a decentralised manner as compared to centralised training.MethodsSLMTA was implemented in five pilot laboratories in Cameroon between October 2010 and October 2012 by means of a series of workshops, laboratory improvement projects and on-site mentorship. The first workshop was conducted in the traditional centralised approach. The second and third workshops were decentralised, delivered on-site at each of the five enrolled laboratories. Progress was monitored by repeated audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist.ResultsAudit scores for all laboratories improved steadily through the course of the programme. Median improvement was 11 percentage points after the first (centralised) training and an additional 24 percentage points after the second (decentralised) training. The estimated per-laboratory cost of the two training models was approximately the same at US$21 000. However, in the decentralised model approximately five times as many staff members were trained, although it also required five times the amount of trainer time.ConclusionDecentralised SLMTA training was effective in improving laboratory quality and should be considered as an alternative to centralised training.

&lt;div class="htmlview paragraph"&gt;The Vision for Space Exploration (VSE) requires vehicles and crew systems designs that include space radiation shielding and protection. Astronauts venturing beyond low Earth orbit (LEO) outside the protection of the Earth's geomagnetic field will be exposed to a much harsher radiation environment due to the potential for solar particle events (SPE). Additionally, long duration missions will subject the crew to higher doses of galactic cosmic rays (GCR). The incorporation of radiation shielding technology into sub-system elements will be crucial to the success of future vehicle designs. One area where radiation shielding may be incorporated is the thermal insulation. As with current crew systems, thermal protection will be a key element in the design. Incorporating radiation shielding into thermal protection systems may be possible by using polymer spheres in place of traditional multi-layer insulation (MLI). By using spheres manufactured from hydrogen rich polymers, which are known to provide a level of shielding against SPE and GCR, the complexity of a system can b e reduced. Using a packed bed of spheres as insulation also allows for the possibility to operate in a w ea k vacuum such as that found on Mars. Under a Phase 1 SBIR contract with the Marshall Space Flight Center (MSFC), a thin heater test apparatus was developed and various polymer sphere samples were tested in both high vacuum and low pressure gas for determination of effective thermal conductivity. The results show that there is potential in the use of polymer spheres as an insulation system.&lt;/div&gt;