Breast Cancer Patients’ Experience about Involvement in Health Care: A Qualitative Study

Background: Patient involvement in health care is a basic patient’s right. Effective communication between the health care professional and the patient is associated with improved psychological functioning of the patient, adherence to treatment, and higher quality of life. Objective(s): This study aims to explore qualitatively breast cancer patients’ experience and satisfaction with their involvement in cancer care. Methods: This study was carried out among 30 women in different breast cancer care stages through in depth-interviews. The patients were purposively selected from surgery and oncology outpatient clinics and surgery inpatient wards in Medical Research Institute Hospital- Alexandria University, and in Ayadi El-Mostakbal Cancer Care Center – Ayadi El-Mostakbal Charity Foundation, Alexandria, Egypt. Results: Some patients mentioned that they did not know their diagnosis until late, others complained of the harsh non-empathetic way of breaking the news of their disease. Patients, generally, reported a little understanding of their treatment plan, they just followed physician’s instructions without receiving enough explanation. Patients on chemotherapy and radiotherapy expressed their unsatisfied need for information. Patients’ source of information was mainly other patients who suffered from the same disease. Patients, in general, were not familiar with the concept of giving feedback, it was perceived by the majority of them as equivalent to complaining. Some patients believed that complaining could put them in trouble such as receiving harsh blame or even delaying their medication. Conclusion: Patients’ narratives revealed poor involvement in health care and showed dissatisfaction of the majority of patients with their level of involvement.

Identifying the epidemiology of traumatic injury in Benghazi, Libya through the implementation of an electronic trauma registry

Traumatic injury is the leading cause of morbidity and mortality globally, and there is little data in the literature for low middle-income countries (LMIC), although it is slowly growing. Libya has been suffering from low resources that are further strained by an ongoing civil war. Benghazi Medical Centre (BMC) is the only operating trauma public hospital in the country’s eastern region and trauma is on the rise. Currently, there is no system in place to identify the trends of traumatic injuries nor any formal surveillance. The objective of this thesis is to describe the epidemiology of traumatic injuries and identify gaps in the trauma system.Methods: This is a prospective study conducted at BMC’s emergency room through the implementation of an electronic trauma registry, iTrauma application. Data collection occurred during January of 2017 over a 10-day trial period. Upon the traumatic patient’s arrival to the emergency department twenty-five data points were collected and entered into iTrauma. Data points included patient demographics, mechanism of injury and clinical outcomes. Results: A total of 231 patients were evaluated and included into the TR. Males were at higher risk for traumatic injury making up 68% of injured patients. The average age was 31 years old, however, the majority of were in the 0-10 and 31-40 age groups. Falls were the most common cause of injury at 31%, followed closely by motor vehicle collisions at 30%. None of the patients injured in a car collision wore a seatbelt, and half of motorbike collision patients dawned helmets. The most common type of injury was bone fractures at 13% and the most common anatomical region was extremity injuries. The vast majority of trauma patients arrived by private vehicle (57%), whereas 20% arrived by ambulance. In terms of clinical outcome, 36% of patients were either treated and discharged in the ER or discharged by the 2 weeks follow up. However, there was a mortality rate of at least 11%. Conclusion: Traumatic injuries lead to a high mortality rate and carry a large burden to the individual clinically and economically. The implementation of a simple TR was shown to be feasible and has a tremendous value in identifying the epidemiology of traumatic injury, most notably falls and motor vehicle collisions. Advocating for programs that address preventative measures can have remarkable benefits in reducing morbidity and mortality. Furthermore, continued support for TR can evolve with the institution and provide ongoing improvement to quality of car

Public Awareness Knowledge of Availability And Willingness to Use Neurosurgical Care Services in Africa: A CrossSectional ESurvey Protocol

Background: Barriers to care cause delays in seeking, reaching, and getting care. These delays affect low-and middle-income countries (LMICs), where 9 out of 10 LMIC inhabitants have no access to basic surgical care. Knowledge of healthcare utilization behavior within underserved communities is useful when developing and implementing health policies. Little is known about the neurosurgical health-seeking behavior of African adults. This study evaluates public awareness, knowledge of availability, and readiness for neurosurgical care services amongst African adults.

Methodology: The cross-sectional study will be run using a self-administered e-survey hosted on Google Forms (Google, CA, USA) disseminated from 10th May 2021 to 10th June 2021. The Questionnaire would be in two languages, English and French. The survey will contain closed-ended, open-ended, and Likert Scale questions. The structured questionnaire will have four sections with 42 questions; Sociodemographic characteristics, Definition of neurosurgery care, Knowledge of neurosurgical diseases, practice and availability, and Common beliefs about neurosurgical care. All consenting adult Africans will be eligible. A minimum sample size of 424 will be used. Data will be analyzed using SPSS version 26 (IBM, WA, USA). Odds ratios and their 95% confidence intervals, Chi-Square test, and ANOVA will be used to test for associations between independent and dependent variables. A P-value <0.05 will be considered statistically significant. Also, a multinomial regression model will be used.

Dissemination: The study findings will be published in an academic peer-reviewed journal, and the abstract will be presented at an international conference.

Highlights

The burden of neurosurgical diseases is enormous in low- and middle-income countries, especially in Africa.
Unfortunately, most neurosurgical needs in Africa are unmet because of delays in seeking, reaching, and getting care.
Most efforts aimed at reducing barriers to care have focused on improving the neurosurgical workforce density and infrastructure. Little or no efforts have been directed towards understanding or reducing the barriers to seeking care.
We aimed to understand public awareness, willingness to use, and knowledge of the availability of neurosurgical care in Africa.
The study findings can inform effective strategies that promote the utilization of neurosurgical services and patient education in Africa.

Patterns of care of breast cancer patients in Morocco – A study of variations in patient profile, tumour characteristics and standard of care over a decade

Guided by a national cancer plan (2010–19), Morocco made significant investments in improving breast cancer detection and treatment. A breast cancer pattern-of-care study was conducted to document the socio-demographic profiles of patients and tumour characteristics, measure delays in care, and assess the status of dissemination and impact of state-of-the-art management. The retrospective study conducted among 2120 breast cancer patients registered during 2008–17 at the two premier-most oncology centres (Centre Mohammed VI or CM-VI and Institut National d’Oncologie or INO) also measured temporal trends of the different variables.

Median age (49 years) and other socio-demographic characteristics of the patients remained constant over time. A significant improvement in coverage of the state-financed health insurance scheme for indigent populations was observed over time. Median interval between onset of symptoms and first medical consultation was 6 months with a significant reduction over time. Information on staging and molecular profile were available for more than 90% and 80% of the patients respectively. Approximately 55% of the patients presented at stage I/II and proportion of triple-negative cancers was 16%; neither showing any appreciable temporal variation. Treatment information was available for more than 90% of the patients; 69% received surgery with chemotherapy and/or radiation. Treatment was tailored to stage and molecular profiles, though breast conservation therapy was offered to less than one-fifth. When compared using the EUSOMA quality indicators for breast cancer management, INO performed better than CM-VI. This was reflected in nearly 25% difference in 5-year disease-free survival for early-stage cancers between the centres.

Undergraduate Surgical Education: a Global Perspective

Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.

Cerebral aneurysms in Africa: A scoping review

Introduction
The epidemiology, management, and prognosis of cerebral aneurysms in Africa remain poorly understood. Most data to date has been from modeling studies. The authors aimed to describe the landscape of cerebral aneurysms in Africa based on published literature.

Methods
Articles on cerebral aneurysms in Africa from inception to June 9, 2020, were pulled from multiple databases (Medline, World Health Organization (WHO) Global Health Library/Global Index Medicus African Journals Online, and Google Scholar). The search results were merged, uploaded into Rayyan. After deduplication, titles and abstracts were screened independently by four reviewers (FDT, USK, IN, NDAB) based on the pre-defined inclusion and exclusion criteria. A full-text review was conducted, followed by data extraction of study, patient, neuroimaging, therapeutic, and prognostic characteristics.

Results
Thirty-three articles were included in the full-text retrieval. These studies were published across 13 (24.0%) countries, notably in Morocco (30.3%, n = 10) and South Africa (15.2%, n = 5), and 14 (42.4%) of them were published on or after 2015. Together, the studies totaled 2289 patients; there was a female predominance in 18 (54.5%) study cohorts, and the most frequently cited aneurysms were located in the internal carotid (12.1%, n = 352) and anterior cerebral arteries (9.5%, n = 275). Open surgery (27.3%, n = 792) was the most widely used option in these studies ahead of coiling (3.2%, n = 94). The reported mortality rate following surgical intervention was 7.9%.

Conclusion
There are few peer-reviewed reports of aneurysm practice and variability in access to cerebral aneurysm care in Africa.

Burden of Cervical Cancer in the Eastern Mediterranean Region During the Years 2000 and 2017: Retrospective Data Analysis of the Global Burden of Disease Study

Background:
Cervical cancer is a growing health concern, especially in resource-limited settings.

Objective:
The objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach.

Methods:
We used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD’s data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group.

Results:
The absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively).

Conclusions:
We found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.

Neurosurgery in Egypt from ancient Egyptians to Modern Neurosurgery, African Perspective

Neurosurgery has been practiced for more than 12,000 years worldwide. Cranial and transnasal approaches to the brain have been practiced for variable religious, mystical, or therapeutic purposes in ancient civilizations of Africa and specifically in Egypt (1). Ancient Egyptian medicine is documented in the paintings on the walls of temples and numerous papyri (figure 1) (2-4).

Ancient Egyptian medicine dates to 3500 BC when Athotis (Hor-Aha), the second king of the first dynasty, was found to have in his tomb the first “Book of the Dead” that was later quoted with modifications till it reached “Practical Medicine and Anatomic Book” in Ani’s papyrus

Moroccan Neurosurgery: Current Situation and Its Contribution to Global Neurosurgery

The first neurosurgical departments were created in the country in 1960, one in Rabat and Casa Blanca. Non-Moroccan neurosurgeons chaired these departments, and between 1960 and 1975, four local neurosurgeons would take over. After The first Medical school in Morocco opened in Rabat in 1962, a training program in neurosurgery was set up in 1968. The first trained Moroccan neurosurgeons were very active. They encouraged the development of local training in Morocco with additional training in foreign countries to increase the number of neurosurgeons and support the organization and promote neurosurgery in the country. They also convinced health policymakers to include neurosurgery in the Moroccan health care system as a priority with an upgrade of the specialty first in all university hospitals and then in all regional hospitals according to the needs. By supporting local training, Morocco ended up in 1998 with eighty native neurosurgeons while there were none in 1956. With nine neurosurgical departments, four of these were inside University Hospitals and with a National Society of Neurosurgery, created in 1984 (1). Other medical and surgical specialties also developed simultaneously as neurosurgery and ended up with a training program. Since then, the evolution of Moroccan Neurosurgery has been continuous, rapid, and outstanding, and many advances have been achieved in the last two decades (1). Two significant events marked the evolution of Moroccan Neurosurgery in these previous two decades:

1.The organization of the 13th world congress in Marrakech in 2005, “Bridging the Gap in Neurosurgery,” considered as the first international gathering of Neurosurgeons, draws the Global Neurosurgery concept and take the attention of the international neurosurgical community in the huge gap between HICs and LMICs regarding a number of neurosurgeons and neurosurgical practice mainly in Africa (2).
2.The decision of the WFNS to leadership the creation of the first WFNS Reference center in Rabat to train young African Neurosurgeons from sub-Saharan Africa, which had a positive impact on the evolution of neurosurgery in Morocco but also in all continent (3).

Andersen’s utilization model for cataract surgical rate and empirical evidence from economically-developing areas

Abstract
Background
Un-operated cataract is the leading cause of vision loss worldwide, responsible for 33% of visual impairment, and half of global blindness. The study aimed to build a fast evaluation method utilizing Andersen’s utilization framework and identify predictors of cataract surgical rate in sub-Saharan Africa and China.

Methods
The study was a cross-over ecological epidemiology study with a total of 19 countries in sub-Saharan Africa, and 31 provinces in China. Information was extracted from public data and published studies. Linear regression and structural equation modeling with Bootstrap were used to analyze predictors of CSR and their pathways to impact in sub-Saharan Africa and China separately.

Results
Cataract surgical resources in sub-Saharan Africa were linearly correlated with CSR (β = 0.74, 95% CI: 0.09, 0.91), while GDP/P didn’t impact cataract surgical resources (β = 0.29, 95% CI: − 0.12, 0.75). In China, residents’ average ability to pay was confirmed as the mediator between GDP/P and CSR (p = 0.32, RMSEA = 0.07; βCSR-paying = 0.77, 95% CI: 0.25, 0.90; βpaying-GDP/P = 0.89, 95% CI: 0.82, 0.93).

Conclusions
In sub-Saharan Africa, CSR is determined by health care provision. Local economic development may not directly influence CSR. Therefore, international assistance aimed to providing free cataract surgery directly is crucial. In China, CSR is determined principally by health care demand (ability to pay). To increase CSR in underserved areas of China, ability to pay must be enhanced through social insurance, and reduced surgical fees.