Hope Africa University

OBJECTIVE We aimed to compare a bundle of enhanced feeding strategies, including breastmilk fortification with term and preterm infant formula, rapid feed advancement, and moderate feeding volumes, to a historic control receiving unfortified, slowly advanced, high-volume feeds. METHODS The retrospective observational analysis was conducted in a Burundian rural hospital. We included neonates weighing 1000 to 1700 g at birth, admitted within the first 24 hours of life, and excluded infants who died or were discharged within 7 days of birth. An unfortified, slow feed advance control group receiving expressed breast milk advanced 20 mL/kg/day to a goal of 270 mL/kg/day was compared with 2 fortified, rapid feed advancement intervention groups receiving expressed breast milk fortified with powdered term or preterm infant formula, typically to 26 kcal/oz, advanced 30 mL/kg/day to a goal of 160 mL/kg/day. RESULTS Neonates receiving the feeding bundle significantly reduced the time to regain birth weight (median [IQR]: (13 [9, 20] days) compared with controls (18 [11, 24] days). The preterm formula intervention group experienced 2.8 g/day higher average daily weight gain during the first 3 weeks of life (95% CI, 0.17–5.56 g/day) compared with the unfortified control group. No significant differences were observed between the intervention and control groups in feeding intolerance, necrotizing enterocolitis, or mortality. CONCLUSION Fortifying breast milk with preterm infant formula combined with rapid feed advancement may be a feasible, effective strategy to improve early weight gain in preterm neonates. This is relevant in low-income settings where nutrition support products are not readily available.

The district hospital is a vital part of the healthcare system in sub-Saharan Africa. It is the key to enabling Primary Health Care to be done well, which in turn can allow for Universal Health Coverage to be achieved. There are numerous challenges at district hospitals making successful ones somewhat rare. One example of a successful district hospital is put forth in this article. In order to increase the number of successful district hospitals a means of sharing solutions to common problems needs to be created, which would ideally be an online repository of said solutions, available to any interested district hospital.

BackgroundThe Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children’s Surgery (OReCS) document in 2019, listing standards of children’s surgical care by level of healthcare facilities within low resource settings. We have previously created and piloted an audit tool based on the OReCS criteria in a high-income setting. In this study, we aimed to validate its use in identifying gaps in children’s surgery provision worldwide.MethodsOur OReCS audit tool was implemented in 10 hospitals providing children’s surgery across eight countries. Collaborators were recruited via the Oxford Paediatrics Linking Our Research with Electives (OxPLORE) international network of medical students and trainees. The audit tool measured a hospital’s current capacity for children’s surgery. Data were analysed firstly to express the percentage of ‘essential’ criteria met for each specialty. Secondly, the ‘OxPLORE method’ was used to allocate each hospital specialty a level based on procedures performed and resources available. A User Evaluation Tool (UET) was developed to obtain feedback on the ease of use of the tool.ResultsThe percentage of essential criteria met within each category varied widely between hospitals. The level given to hospitals for subspecialties based on OReCS criteria often did not reflect their self-defined level. The UET indicated the audit tool was practicable across multiple settings.ConclusionsWe recommend the use of the OReCS criteria to identify areas for local hospital improvement and inform national children’s surgical plans. We have made informed suggestions to increase usability of the OReCS audit tool.

The growing burden of Parkinson's disease (PD) in Africa necessitates the identification of available therapies and services to improve patient care. To investigate the availability, affordability, frequency of usage, and insurance coverage of PD therapies (pharmacological, surgical, physical, and speech therapies) and services including specialized clinics, specialists, and nurses across Africa. A comprehensive web-based survey was constructed and distributed to neurologists/physicians with a special interest in PD across Africa. The survey instrument includes components that address availability, affordability, frequency of use, and insurance coverage of different therapies and services. Responses were received from 28 (of 43 contacted) countries. Levodopa-based oral preparations were always available in 13 countries (46.4%) with variable affordability and "partial or no" insurance coverage in 60% of countries. Bromocriptine was the most available (50%) and affordable ergot dopamine agonists (DA), whereas non-ergot DA was always available in only six countries (21.4%). Trihexyphenidyl was the most available and affordable anticholinergic drug (46.4%). Tricyclic antidepressants and selective serotonin reuptake inhibitors were available in most countries (89.3% and 85.7% respectively), with variable affordability. Quetiapine and clozapine were less available. Specialized clinics and nurses were available in 25% and 7.1% of countries surveyed, respectively. Other services were largely unavailable in the countries surveyed. PD-specific therapies and services are largely unavailable and unaffordable in most African countries. The data provide a platform for organizing strategies to initiate or scale up existing services and drive policies aimed at improving access to care and tailoring education programs in Africa. © 2021 International Parkinson and Movement Disorder Society.

Background:Malaria is a significant cause of morbidity and mortality throughout the world and particularly sub-Saharan Africa. The World Health Organization and many national bodies, including Burundi, recommend artemisinin-based therapy as first-line treatment for uncomplicated and severe malaria. Implementing this recommendation requires healthcare professionals' acceptance of this treatment as the optimal choice.Methods:A survey was conducted among Burundian healthcare professionals from June to September 2017 to assess prescribing preferences regarding artemisinins versus quinine for treating malaria. Healthcare professionals were surveyed from 32 health facilities in 10 provinces. Respondents included both physicians and nurses who provided responses about their antimalarial treatment preferences for a variety of clinical scenarios. Comparisons among healthcare professionals, their level of training, work setting, and length of work experience were examined using a series of stratified analyses, where the Pearson Chi-square statistic and odds ratios with 95% confidence intervals were calculated.Results:Respondents included 101 doctors and 196 nurses. Seventy-nine percent of respondents worked in hospitals, while 58% had more than 5 years of work experience. Although 94% of respondents correctly identified artemisinin-based treatment as first-line therapy according to the national protocol, 24-40% of respondents preferred the use of quinine in various hypothetical clinical scenarios. Overall, nurses were at greater odds of preferring quinine versus artemisinins compared with physicians. Availability of artemisinins was associated positively with artemisinin preference. These results did not vary by duration of work experience.Conclusions:Though knowledge of artemisinin-based therapy was recognised by the majority of respondents as the recommended antimalarial treatment, a high proportion of Burundian healthcare professionals, especially nurses, prefer using oral and IV quinine in a number of clinical scenarios. These findings identify a significant barrier to the satisfactory implementation of a life-saving treatment in accordance with national and international recommendations.

Gender affects the kind of opportunities and constraints faced in life; human beings are constantly divided into hierarchies. In looking at poverty reduction in Burundi, we can see the critical role that gender plays. In Burundi, among the poor are many women as a result of being primary caretakers. The focus of this paper is to examine the interconnection between gender and poverty reduction as well as the role of social work, if there is to be any reduction in poverty. Social workers need to work with women who are at the forefront of poverty through encouragement of more opportunities for women in education, business and in areas of decision-making. In many areas women are regarded as unable to participate with men in decision-making as they are considered not to be on the same level with men, intellectually, socially, economically or politically. When a woman is educated, she is better able to provide for her children. This means that the future generations are also protected against poverty. Social workers have the role of educating women and men in Burundi about the importance of women in poverty reduction. This paper presents a brief review of literature on gender disparities and poverty as well as the role of social work in poverty reduction in Burundi.

Introduction: Diphenhydramine (DPH) exposures in children may be the result of accidental unsupervised ingestions, caregiver error, and intentional misuse of DPH-containing cough and cold medications (CCM). We sought to understand the nature of pediatric ingestions of DPH, particularly the toxicity and outcome of a single product, single ingredient DPH (DPH-only) exposures, in order to derive ingredient-specific information about the clinical effects and course of such cases.Methods: As part of a U.S. multi-year safety surveillance program to assess the safety of over-the-counter (OTC) medications used in cough and cold preparations in children <12 years of age, an expert panel reviewed cases involving symptomatic adverse events potentially related to oral exposures to these medications. After individual review, the cases were categorized by causal relationship of the reported ingredients to the adverse event, exposure intent (therapeutic, non-therapeutic, unknown intent), and dose (therapeutic, supratherapeutic, or unknown). Following panel review, any disagreement on classification was discussed until a consensus was reached. The data were then analyzed with respect to descriptive findings.Results: The panel reviewed 6618 eligible cases and determined 2802 were at least potentially related to oral exposure to DPH. Of these, 2028 were DPH-only cases (39.1% of all cases judged at least potentially related to a cough and cold medication). The majority (79.5%) of DPH-only cases occurred in children 2 to <4 years of age and involved accidental unsupervised ingestions (74.7%). Liquid pediatric formulations were the most common (51.7%) products reported followed by solid pediatric formulations (24.0%). The most common adverse events were tachycardia (53.4%), hallucinations (46.5%), somnolence (34.7%), agitation (33.9%), and mydriasis (26.3%). Seizures occurred in only 5.5% of cases. Five (0.2%) deaths were reported; in the death cases, the DPH dose was judged supratherapeutic in one and unknown in the other four. Child abuse was reported in four of the five death cases and three of the five deaths were homicides.Conclusions: Exposures to DPH-only products were the most common type of exposure detected in our study of adverse events associated with CCM in children. The majority of the DPH-only cases were the result of accidental unsupervised ingestions. Most adverse events were relatively mild self-limited anticholinergic effects and few deaths occurred. Deaths involving DPH were often associated with child abuse or homicide. Interventions targeting the prevention of accidental unsupervised are likely to be impactful in preventing morbidity associated with DPH-only exposure.