Tuesday, November 24, 2020

First medical training school to be opened in Sudan rebel-held territory next year

By Esther Nakkazi 

Last week Dr. Tom Catena the only surgeon for approximately 1.3 million people in the Nuba Mountains of South Kordofan, Sudan announced the opening of a medical training school next year in the rebel-held territory.

“There has been a tremendous upgrade in medical capacity over these past 13 years but despite these efforts, there remains a huge deficit in medical personnel in Nuba. We now believe that the only way to address that huge shortfall is to open a training school here, and train our own, nurses, midwives and clinical officers,” said Dr. Catena during a virtual World Innovation Summit for Health (WISH), a global healthcare community dedicated to capturing and disseminating the best evidence-based ideas and practices. 

“We are now in the early planning stages of this school, and hope to have it up and running within the next year.” 

The medical school will be attached to the Gidel Mother of Mercy Hospital, which he helped establish and open in 2008 and remains the only major provider of medical care in the Nuba mountains region. The hospital has been relying on heroic on-the-job trained staff but now wants to have fully trained professionals. 

‘Dr. Tom’ as he is affectionately known, has served in Africa for more than 20 years and works and lives in rebel-held territory, around the size of Austria, which has known civil war, starvation, and genocide ever since the founding of the Sudan republic in 1956. 

Funds to run the Gidel Mother of Mercy Hospital mostly come from individual donors, well-wishers, except for donations of food, vaccines, and TB drugs but they don’t receive anything from the International donor community which has made them rather frugal in their operating expenses. 

It will require about USD $800,000 to run the 435-bed hospital and the training school for a year and they would provide most of the basic services and low cost. By way of comparison, a similar-sized hospital in Dr. Catena’s home area in the US would have an annual operating budget of 400 times this amount of money annually which if availed to the Gidel Mother of Mercy Hospital and training school would be sufficient for the next 400 years. 

“Good health care, education, do not need to be prohibitively expensive. We feel that we can provide a good number of services at a very low cost …. perhaps, the problem isn’t lack of money, but just a gross maldistribution of resources,” said Dr. Catena. 

Although life in Nuba has improved due to a cessation of hostilities however the Nuba are people deeply traumatized due to centuries of oppression and marginalization at the hand of cards emulate. 

The training it is believed will uplift the respect of the Nuba people who have proven themselves as tough warriors over the years but have been humiliated, degraded, and grown accustomed to being treated as second class citizens in their own country with little hope that they will be treated as the equals be the Northerners. 

“We encourage our staff, that as a way to get respect, will be by using their intellect and skill to show their detractors that they are the equal of anyone,” said Dr. Catena. “It is our sincere hope that our initiatives to train our staff will put them on an equal footing with health practitioners anywhere in the world.” 

The hospital is already receiving patients from as far as Khartoum. “We hope that with our clinical school will become a training center for all of Sudan, both students and patients will come to us seeking care. It is much more difficult to despise someone if he or she is the one performing your surgery or diagnosing your complex medical problems,” he said. 

“It is our dream that one of the dividends of a first-grade hospital and training program will bring peace in our troubled region,” concluded Dr. Catena at the WISH conference. WISH is an initiative of Qatar Foundation for Education, Science and Community Development (QF) and is under the patronage of Her Highness Sheikha Moza bint Nasser, its Chairperson.

Wednesday, November 4, 2020

Women and Water: Collecting water causes serious injuries says study

By Esther Nakkazi

Collecting water can cause serious injuries like falls, traffic accidents, animal attacks, and fights, which can result in broken bones, spinal injuries, lacerations, and other physical injuries, particularly for women living in low and middle-income countries according to new research from the University of East Anglia (UEA).

The research titled ‘In pursuit of ‘safe’ water: The burden of personal injury from water fetching in 21 low-income and middle-income countries’ published in the journal BMJ Global Health also says women are also most likely to sustain such injuries – highlighting the social and gender inequities of a hidden global health challenge. 

“Millions of people don’t have the luxury of clean drinking water at their home, and they face many dangers before the water even touches their lips. We wanted to better understand the true burden of water insecurity," says Dr Jo-Anne Geere, from UEA’s School of Health Sciences.

Dr. Geere says most of the global research on water has largely focused on scarcity and health issues related to what is in the water, but the burden and risks of how water is retrieved and carried has been overlooked until now.

The new study was led by Northwestern University in the US, in collaboration with UEA, the University of Miami, and the Household Water Insecurity Experiences Research Coordination Network (HWISE RCN).
The research team used a large global dataset to understand what factors might predict water-fetching injuries. The work draws on a survey of 6,291 randomly selected households across 24 sites in 21 low- and middle-income countries in Asia, Africa, Latin America, and the Caribbean.

They found that 13 per cent of the respondents reported some sort of injury while collecting water, and that women were twice as likely to be hurt as men.

 “Thirteen percent is a big number, but it is probably an underestimate. It’s highly likely that more people would have reported injuries if the survey had more detailed questions," says Dr. Sera Young, from Northwestern University.

“This reinforces how the burden of water scarcity disproportionately falls on women, on rural populations, and on those who do not have water sources close to home. It highlights the importance of safe interventions that prioritise personal physical safety alongside traditional global indicators of water, sanitation, and hygiene,” says Prof Paul Hunter, from UEA’s Norwich Medical School.

The researchers say that keeping track of such safety measures — in addition to the usual measures of water quality and access — could help better assess progress towards the United Nations’ Sustainable Development Goal 6.1, which sets out “to achieve universal and equitable access to safe and affordable drinking water for all” by 2030.

“It seems likely that water-fetching can contribute considerably to the global Water, Sanitation, and Hygiene (WaSH) burden, but it usually goes unmeasured because we typically think about access and water quality. It is, therefore, a greatly underappreciated, nearly invisible public health challenge," Dr. Vidya Venkataramanan, also from Northwestern University.

“It’s really important that data on water-fetching injuries are systematically collected so that we can know the true burden of water insecurity. Currently, all of the broken bones, spinal injuries, lacerations, and other physical injuries are not accounted for in calculations about the burden of water insecurity.”



Monday, November 2, 2020

Study uncovers ‘enormous burden of dengue’ among Kenyan children

Researchers uncovered what they called “an enormous burden of dengue fever among children with undifferentiated febrile illness in Kenya.”

Specifically, out of more than 1,000 children ill with fever, more than 40% were infected with the dengue virus. Many children with dengue and without malaria were treated with antimalarial drugs, antimicrobial drugs, or both, according to a report in Emerging Infectious Diseases.

Dengue, which is endemic in more than 100 countries, “is an important cause of illness among children in Kenya, and clinicians should consider dengue as a cause of unlocalized fever,” Melisa M. Shah, MD, MPH, an endowed postdoctoral fellow at Stanford Medicine, told Healio.

“Often, fever is considered to be malaria and empiric treatment is given,” Shah said. “The lack of awareness about dengue as a cause of febrile illness is one factor causing the overdiagnosis and overtreatment of malaria.”

Shah and colleagues tested blood samples from 1,022 Kenyan children with ongoing febrile illness from 2014 to 2017. Of the 862 viable samples, dengue viremia was detected in 361 (41.9%). Of those 361 samples, 333 were classified as primary infections (92.2%), 14 were secondary infections (3.9%) and the remaining 14 samples lacked dengue virus immunoglobulin G data.

Of the 1,022 study participants, 419 (41%) received antimalarial drugs, Shah and colleagues reported. Antimalarial drugs were more likely to be administered to patients with dengue virus viremia — 48.8% vs. 36.8%. Among 141 study participants who had confirmed dengue without malaria, 29 (20.6%) received an antimalarial drug (20.6%), 75 received an antimicrobial drug (53.2%) and 12 received both (8.5%).

“The unnecessary use of antimalarials and antibiotics exposes children to known medication side effects and may contribute to the development of drug resistance,” Shah said. Participants with dengue virus viremia with febrile illness reported headaches (49.6%), poor appetite (46.8%), cough (45.7%) and joint pain (36.8%).

“An accurate, reliable, and affordable point-of-care diagnostic for dengue is urgently needed for health practitioners in outpatient settings in endemic areas,” Shah said. “Such a diagnostic could quickly identify whether dengue may be the cause of febrile illness.”

According to a CDC summary of the study, genetic testing revealed that some of the strains of dengue virus were not typical to Africa and may have been imported by travelers from other continents.

“The paucity of dengue surveillance studies and sequence data from Africa is striking,” Shah and colleagues wrote in their paper. WHO estimates that around half of the world’s population is currently at risk for dengue, which is typically found in urban and semi-urban areas in tropical and sub-tropical climates.

Researchers predicted last year that the geographical range of dengue would place 60% of the world’s population at risk by 2080. Right now, an estimated 100 million to 400 million dengue infections occur each year, according to WHO.

There is no specific treatment, although there is an approved dengue vaccine.“Dengue activity will likely continue to spread in Africa because of rapid land-use change, climate change, urbanization, increased human travel and international trade,” Shah and colleagues wrote.

“Knowledge of the spatial-temporal dynamics of dengue circulation throughout Africa is critically needed to inform a coordinated public health response in an increasingly interconnected world.”