Posts or Comments 15 July 2024

Archive for "Chronic/NCDs"



Cholera &Chronic/NCDs &Environment &Health Systems &Measles &Yellow Fever Bill Brieger | 27 Mar 2024

Challenges Facing Public Health in 21st Century Africa

Solomon Afolabi has delved into the challenges for public health in 21st Century Africa in the posting below. He is currently an Advisor to the Upper Nile Institute (UNI) of South Sudan, Kiryandongo, Uganda and an Alumnus of the Johns Hopkins Bloomberg School of Public Health and its African Public Health Network.

As we move further into the 21st century, the challenges facing public health in Africa are becoming increasingly complex and difficult to address. Despite numerous advancements in medical technology, many African nations continue to struggle with a wide range of health issues, which have been their most pressing challenges. These issues span a wide spectrum, from infectious diseases like cholera, malaria, Ebola, HIV, and more recently, coronavirus, to an escalating burden of chronic diseases. However, these health concerns are not isolated; they intersect with broader socio-economic factors such as povertyarmed conflicts, and government mismanagement. WHO in April 2023 stated that, “for all the hard-won gains that have been made over the past 75 years, more than 100 health emergencies still occur in the African Region annually, including outbreaks of cholera, yellow fever, meningitis, measles, and Ebola. These emergencies still pose a significant threat to the health, well-being, and development of African countries”

Photo: Cholera active case finding team, Kalikiliki settlement in Lusaka, Zambia (October, 2023)

The battle against infectious diseases in Africa is still ongoing. While a significant number of these diseases have been largely eradicated in other parts of the world, they continue to pose a serious threat to the health and well-being of millions of people across the continent. As earlier stated, these diseases including tuberculosis  are still major public health concerns in many African nations, and efforts to address these issues are often complicated by factors such as poverty, lack of access to healthcare, limited resources and governments not making meaningful investments.

Another major challenge facing public health in Africa is the rising incidence of non-communicable diseases (NCDs), which includes conditions such as cancer, diabetes, and cardiovascular disease, often associated with lifestyle factors such as diet, exercise, and smoking. Contrary to the traditional thought of NCDs as diseases of affluence, they are becoming increasingly prevalent in many African countries. This is partly due to changing lifestyles and the adoption of more westernized diets, as well as limited access to preventative healthcare services.

A third major challenge facing public health in Africa is the impact of environmental factors on health. Poor air quality, contaminated water, and inadequate sanitation are all major factors contributing to a range of health problems across the continent. In many cases, these environmental factors are linked to poverty and lack of access to basic resources such as clean water and sanitation facilities. Climate change is also expected to have a significant impact on public health in Africa in the coming decades, with rising temperatures and changing weather patterns likely to exacerbate existing health challenges.

Photo: Climate change projected to cause global food shortages, WHO-AFRO

Furthermore, there is the challenge of ensuring that healthcare services are accessible and affordable to all. Many African nations continue to struggle with limited resources and infrastructure when it comes to healthcare and ensuring that all individuals have access to basic healthcare services remains a significant challenge. This is compounded by factors such as corruption, political instability, and conflict, which can disrupt healthcare services and limit access to care. Despite these challenges, there are also reasons for optimism when it comes to public health in Africa. Advances in medical technology and healthcare delivery are helping to address many of these issues, and there is growing awareness of the importance of preventative healthcare measures such as vaccination and early detection. Additionally, there are many dedicated healthcare professionals and organizations working tirelessly to improve vaccine production and health outcomes across the continent.

In conclusion, the challenges facing public health in 21st century Africa are many and varied. From the ongoing battle against infectious diseases to the rising incidence of non-communicable diseases and the impact of environmental factors on health, there are many complex issues that need to be addressed. However, with continued investment and dedication, there is reason to believe that progress can be made in improving health outcomes for all Africans.

Chronic/NCDs &Community &Training Bill Brieger | 08 Jan 2022

Freedom Park Lagos Hosts Revolving Hearts Foundation CPR Training & AED Presentation

In their 2021 presentation at the American Society of Tropical Medicine and Hygiene, “Hands-only CPR Training Program of Secondary School Students in Ibadan, Nigeria”, Olufunso Odunukan and colleagues of the Revolving Heart Foundation mentioned that plans were underway to expand the training. Below, they share their recent public training in Lagos, Nigeria.

Freedom Park Lagos played host to the Revolving Hearts Foundation (RHF) – a non-governmental organisation which advocates Cardiopulmonary Resuscitation (CPR) trainings and more of the presence/ use of Automated External Defibrillator (AED) in public places in Nigeria (and by extension Africa). The foundation represented by its visionary Dr. Olufunso Odunukan, an interventional cardiologist based in the United States, took a wide cadre of staff – from management to the most junior level, and vendor representatives through a detailed and practical session of administering CPR in a bid to save more lives and reduce loss due to not-quick-enough basic interventions in the face of a cardiac arrest or someone passing out due to a heart attack.

The NGO also presented an AED to the management of Freedom Park and in the same training showed how to set up the device following previously programmed instructions on the gadget. After that, with the use of mannequins and simulated AED materials, the RHF representative Dr. Odunukan took the participants through a very hands-on and practical experience of deploying CPR in a model situation. There was a video presentation that detailed what to do in the event a person suffers a cardiac arrest in a public place, at home, on the sidewalk, on stage or similar places.

The participants who included a wide array – cleaners, vendor workers, senior staff and middle management all gave good feedback as to the extent and impact that the training would have, even beyond the four walls of the Park. They also participated in a skit of a proper situation where they might need to take charge or be part of helping in an emergency situation, especially with the benefit of the lessons they had picked up in the training.

Dr. Odunukan equally advocated that this shouldn’t be a one-off session as the training could be replicated from time to time, so that everyone is prepared and savvy in the proper manner to be able to intervene and save lives, at least as a first aid in such situations, until professional medical assistance arrives. After the latter, on behalf of RHF, he presented the AED to the management of Freedom Park represented by the C.O.O.  Ms. Iyabo Aboaba who gladly accepted the device and reiterated the necessity of such gesture with the pledge to put it to good use, in line with the vision of the NGO to save more lives.

The training which lasted about 1hour 30 minutes ended with FAQs and an interactive and enlightening session based on the model skit and how to replicate an efficient process in the event of a real-life situation.

Chronic/NCDs &NCDs &Schools &Training Bill Brieger | 19 Nov 2021

Hands-only CPR Training Program of Secondary School Students in Ibadan, Nigeria

NCDs are increasingly being recognized as health problems in Nigeria and other LMICs.  Here, Bolanle Akinyele, Olufunso Odunukan, Oluwaseyi Bolorunduro, and William Brieger describe a Pilot project to help high school students learn to perform CPR through a Combination Virtual and In-person Learning. This is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting.

Out-of-hospital cardiac arrest (OHCA) is estimated to have an average global incidence of 55 adults per 100,000 person-years. However, despite advances in medical care and technology, survival to hospital discharge remains abysmally low at 8-10%. In low to middle income countries like Nigeria, where cardiovascular disease is rising but emergency response systems are poor, the rate of survival after OHCA is lower.

Interventions such as bystander cardiopulmonary resuscitation (CPR) training and automated external defibrillator (AED) use are effective, scalable, and low-cost interventions that can reduce the OHCA mortality. Training schoolchildren to perform Hands-only CPR has been shown to increase bystander CPR.

Cardiopulmonary Resuscitation Peer Educator’s Program (CPEP) is a community-based program in Ibadan, Nigeria, designed enhance understanding of CPR in secondary school students. The American Heart Association’s school health module was adapted. The training was run jointly by staff of the four pilot schools, a Nigerian NGO, and the Revolving Hearts Foundation, Atlanta.

The training had both in-person and virtual components due to COVID-19 travel restrictions on Atlanta based partners. Here we present the results of training on knowledge, comfort level and perceived barriers of performing hands-only CPR.

A pre-training survey was conducted in February 2021 using convenience sampling that also was used to recruit participants. Pre- and post- training responses were matched by participants to assess the changes. Data were analyzed using Stata 16.1 software. A paired t-test analysis was conducted. The primary outcome was a percentage change in mean knowledge scores and secondary outcome was a change in comfort level and perceived barriers pre- and post- training.

A total of 45 secondary school students from 4 schools completed the tests. Females comprised 31.1% of students and the average age was 15.02 + 0.18 years. Paired t-test showed a significant change of 44.6% (p <0.0001) in the mean knowledge score. There was also an increase in comfort level in performing hands-only CPR, and a decrease in perceived barriers.

Trainees have started sharing what they learned through skits at school assemblies. Planning is underway to follow-up on training and to expand to other schools and states.

PS: as a followup another training session with a new group of 45 students and 15 teachers was conducted. The students made videos of their understanding of CPR from the program so it could be used for peer education, and most of them were pretty good and creative.

Chronic/NCDs &Epidemiology &Mortality &Severe Malaria Bill Brieger | 19 Sep 2013

Are non-communicable diseases actually communicable?

Much of the discussion around global health and post-Millennium Development Goals focuses on non-communicable diseases (NCDs) including cardiovascular problems, diabetes, cancers and the the like.  While it is important to recognize that low income nations are not plagued with both communicable and non-communicable diseases, we do not want the greater focus on NCDs in richer countries to overshadow the problems of malaria, pneumonia, TB, diarrhea and other child killers in poorer countries.

dscn7742-chw-flipchart.jpgA major reason for us not to lose focus on communicable diseases was recently reported from the Wellcome Trust on research they have supported in Malawi. The researchers found that the malaria parasite, Plasmodium falciparum, is able to “cause inflammation in blood vessel walls, making them more sticky so that the infected red blood cells can cling to the sides. Being able to stick to the blood vessels in vital organs allows the parasite to hide away from the immune system, a process called sequestration. When it occurs in the brain it causes a more severe form of the disease called cerebral malaria, associated with seizures, coma and sometimes death.”

The researchers also surmised that if this complication does not kill people in childhood, the damage to blood vessel walls can have more long lasting effects. In particular they noted that, “Chronic changes to the blood vessels like these could an important contributing factor to cardiovascular disease later in life.”

The link between malaria and Endemic Burkitt lymphoma (eBL) continues to be explored. Recently adding to this long history of eBL research, Peter Aka and colleagues reported that. “Anti–HRP-II (Plasmodium falciparum histidine-rich protein-II) antibodies suggest that recent malaria infection triggers the onset of eBL.”

In a review of intrauterine growth retardation (IUGR) Demicheva and Crispi observed that, “Several clinical and experimental studies showed that IUGR fetuses present signs of cardiac dysfunction in utero that persist postnatally and may condition higher cardiovascular risk later in life.” In endemic regions, malaria in pregnancy is a major cause of IUGR and thus low birth weight.

Preventing malaria therefore saves lives now and in the future. Ignoring malaria now adds greater burdens to the health system and national productivity tomorrow. We need to maintain our investments in malaria both globally and in and by endemic countries themselves.