This chapter is based on persons with physical disabilities in Africa, their challenges, and how it affects their health-seeking behaviors. We noticed that physical challenge has a substantial long-term adverse effect on one’s ability to carry out normal day-to-day activities. Both the causes and the consequences of physical disability vary throughout the world, especially in Africa. Environmental, technical, and attitudinal barriers and consequent social exclusion reduce the opportunities for physically challenged persons to contribute productively to the household and the community and further increase the risk of falling into poverty and poor healthcare services. The inability of the physically challenged persons to perceive the lack of points of interest of government has intensified to make significant recommendations and possible solutions. This is appalling because the rate to which a community provides and funds restoration is a way of grading how much interest it has, and importance it connects to the quality of life of its citizens. We advocate and recommend swift actions and disability inclusiveness to accommodate persons with physical disabilities in Africa for them to have a good perception of life.
State of African neurosurgical education: a protocol for an analysis of publicly available curricula
Background
Africa bears >15% of the global burden of neurosurgical disease. Yet to date, Africa still has the lowest neurosurgical workforce density globally, and efforts to fill this gap by 2030 need to be multiplied. Although the past decade has seen an increase in neurosurgery residency programs in the continent, it is unclear how these residency programs are similar or viable. This study aims to highlight the current status of neurosurgical training in Africa as well as the differences within departments, countries or African regions.
Methods
A literature search using keywords related to ‘neurosurgery’, ‘training’, and ‘Africa’ and relevant names of African countries will be performed on PubMed and Google Scholar. If unavailable online, the authors will contact local neurosurgeons at identified training programmes for their curricula. The residency curricula collected will be analysed against a standardized and validated medical education curriculum viability tool.
Results
The primary aim will be the description of African neurosurgical curricula. In addition, the authors will perform a comparative analysis of the identified African neurosurgical curricula using a standardized and validated medical education curriculum viability tool.
Discussion
This study will be the first to evaluate the current landscape of neurosurgery training in Africa and will highlight pertinent themes that may be used to guide further research. The findings will inform health system strengthening efforts by local training programme directors, governments, policymakers and stakeholders.Background
Africa bears >15% of the global burden of neurosurgical disease. Yet to date, Africa still has the lowest neurosurgical workforce density globally, and efforts to fill this gap by 2030 need to be multiplied. Although the past decade has seen an increase in neurosurgery residency programs in the continent, it is unclear how these residency programs are similar or viable. This study aims to highlight the current status of neurosurgical training in Africa as well as the differences within departments, countries or African regions.
Methods
A literature search using keywords related to ‘neurosurgery’, ‘training’, and ‘Africa’ and relevant names of African countries will be performed on PubMed and Google Scholar. If unavailable online, the authors will contact local neurosurgeons at identified training programmes for their curricula. The residency curricula collected will be analysed against a standardized and validated medical education curriculum viability tool.
Results
The primary aim will be the description of African neurosurgical curricula. In addition, the authors will perform a comparative analysis of the identified African neurosurgical curricula using a standardized and validated medical education curriculum viability tool.
Discussion
This study will be the first to evaluate the current landscape of neurosurgery training in Africa and will highlight pertinent themes that may be used to guide further research. The findings will inform health system strengthening efforts by local training programme directors, governments, policymakers and stakeholders.
Emergency Medical Services (EMS) Utilization in Zimbabwe: Retrospective Review of Harare Ambulance System Reports
Background: Emergency medical services (EMS) are a critical but often overlooked component of essential public health care delivery in low- and middle-income countries (LMICs). Few countries in Africa have established EMS and there is scant literature to provide guidance for EMS growth.
Objective: This study aimed to characterize EMS utilization in Harare, Zimbabwe in order to guide system strengthening efforts.
Methods: We performed a retrospective chart review of patient care reports (PCR) generated by the City of Harare ambulance system for patients transported and/or treated in the prehospital setting over a 14-month period (February 2018 – March 2019).
Findings: A total of 875 PCRs were reviewed representing approximately 8% of the calls to EMS. The majority of patients were age 15 to 49 (76%) and 61% were female patients. In general, trauma and pregnancy were the most common chief complaints, comprising 56% of all transports. More than half (51%) of transports were for inter-facility transfers (IFTs) and 52% of these IFTs were maternity-related. Transports for trauma were mostly for male patients (63%), and 75% of the trauma patients were age 15–49. EMTs assessed and documented pulse and blood pressure for 72% of patients.
Conclusion: In this study, EMS cared primarily for obstetric and trauma emergencies, which mirrors the leading causes of premature death in LMICs. The predominance of requests for maternity-related IFTs emphasizes the role for EMS as an integral player in peripartum maternal health care. Targeted public health efforts and chief complaint-specific training for EMTs in these priority areas could improve quality of care and patient outcomes. Moreover, a focus on strengthening prehospital data collection and research is critical to advancing EMS development in Zimbabwe and the region through quality improvement and epidemiologic surveillance.
Improvements in Child Cancer Diagnostics and Treatment in Africa
In Africa, more than 50% of cases of childhood cancer go undiagnosed. Africa accounts for 146,000 of the projected 397,000 new cases globally per year (including both diagnosed and undiagnosed cases) (Ward et al, 2019a). Of the diagnosed cases, only 11.6% of children in Africa survive (Ward et al, 2019b). Based on the above modeling exercise, we estimate that only about one-third of those who are diagnosed actually receive treatment; no hard data are available. Increasing access to treatment will increase survival, although to reach survival rates comparable to high income countries, investments will also be needed to decrease treatment abandonment and improve quality of treatment (Ward et al, 2019b).We recommend investing to expand treatment of five key cancers that are both treatable and affordable. These five cancers together account
for 40% of the burden of childhood cancer in Africa. Studies of cost per child treated in subSaharan Africa for three of the conditions (Burkitt lymphoma, nephroblastoma and earlystage retinoblastoma) were $1248, $1976 and $2202 USD respectively in various low- and lower-middle income countries in Africa. More conservatively, costs of a comprehensive cancer centre in one African country which achieved a projected 5-year survival rate of 35% for a cohort of children with multiple cancer types, were around $10,000 per child in 2018 USD, or around 6.5 times per capita GNI (see text below for all study references).
Benefit:cost ratios were estimated as 9.1 to 19.3 for the three diseases for which studies were available, and a more conservative 5.2:1 for a comprehensive centre which treats not only the priority diseases, but also provides treatment for other less-treatable conditions and palliative care to children for whom cure is not possible. Ratios would be a little lower (4.6:1) but still very attractive if indirect costs to families were included in treatment costs, and higher if non-profit organizations took the lead in small investments to reduce treatment abandonment rates, as has been done successfully in a number of low- and middleincome country (LMIC) contexts.
Expanding care from the estimated one-third of those diagnosed to all those currently diagnosed would cost $407m using the comprehensive cancer centre model. This amount would double, if 90% coverage of were attained (i.e. if 80% of all undiagnosed children could be diagnosed and linked to treatment). The value of the benefits would however be an estimated 5.2 times the costs, or $2116m. There are other potential unquantifiable benefits, such as helping to show that cancer is indeed curable and helping reduce the stigma associated with cancer in Africa, potentially leading adults with cancer to seek care earlier and improve their survival. In addition, improving capabilities to treat childhood cancers has the potential to strengthen health systems more broadly, by developing radiologic and pathologic services, medicines procurement and supply management, surgical facilities, health human resource training and retention, and supportive care capacities.
How Climate Change May Threaten Progress in Neonatal Health in the African Region
Climate change is likely to have wide-ranging impacts on maternal and neonatal health in Africa. Populations in low-resource settings already experience adverse impacts from weather extremes, a high burden of disease from environmental exposures, and limited access to high-quality clinical care. Climate change is already increasing local temperatures. Neonates are at high risk of heat stress and dehydration due to their unique metabolism, physiology, growth, and developmental characteristics. Infants in low-income settings may have little protection against extreme heat due to housing design and limited access to affordable space cooling. Climate change may increase risks to neonatal health from weather disasters, decreasing food security, and facilitating infectious disease transmission. Effective interventions to reduce risks from the heat include health education on heat risks for mothers, caregivers, and clinicians; nature-based solutions to reduce urban heat islands; space cooling in health facilities; and equitable improvements in housing quality and food systems. Reductions in greenhouse gas emissions are essential to reduce the long-term impacts of climate change that will further undermine global health strategies to reduce neonatal mortality.
Quality of health care services and performance in public hospitals in Africa: A protocol for systematic review
Background: The delivery of high-quality health care services and performance is the main aim of all health care systems globally. This review objective is to determine the quality of health care services and performance in public hospitals in Africa through a systematic review and meta-analysis of existing studies.
Methods: The search will be conducted in pre-determined databases (e.g., PubMed), for eligible studies between 2000 and 2020, to identify studies published in English, which applied the service quality gap (SERVIQUAL) model to determine the quality of health care services and performance in public hospitals in Africa. The search will also include a review of reference lists of included studies for other eligible studies. Eligible studies will include experimental and observational studies. Two authors will independently screen the search output, select studies and extract data, resolve discrepancies by consensus and discussions. Two authors will use Cochrane risk of bias tools for experimental studies, and Hoy for observational studies. The review will also assess study quality and risk of bias using standardized tools. The review aims to provide comprehensive information on the quality of health care services and performance in public hospitals in Africa.
Discussion: Understanding patients’ or clients’ expectations and perceptions on the quality of health care services provided in the health care systems are very crucial in the improvement of the health status of the general population. The SERVIQUAL model is a standardized tool used to assess the quality gap of patients/clients perspectives on health care services in hospitals globally. The findings from this review will provide information on the quality gap of health care provided in public hospitals in SSA. Also, we anticipate that the findings will inform policymakers in health care systems on how to improve and maintain the quality of health care services in public hospitals in different African settings.
Systematic review registration number: PROSPERO CRD 420212264100 dated 25/07/2021
Burden and trend of colorectal cancer in 54 countries of Africa 2010–2019: a systematic examination for Global Burden of Disease
Background
Colorectal cancer plays significant role in morbidity, mortality and economic cost in Africa.
Objective
To investigate the burden and trends of incidence, mortality, and disability-adjusted life-years (DALYs) of colorectal cancer in Africa from 2010 to 2019.
Methods
This study was conducted according to Global Burden of Disease (GBD) 2019 analytic and modeling strategies. The recent GBD 2019 study provided the most updated and compressive epidemiological evidence of cancer incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and DALYs.
Results
In 2019, there were 58,000 (95% UI: 52,000–65,000), 49,000 (95% UI: 43,000–54,000), and 1.3 million (95% UI: 1.14–1.46) incident cases, deaths and DALYs counts of colorectal cancer respectively in Africa. Between 2010 and 2019, incidence cases, death, and DALY counts of CRC were significantly increased by 48% (95% UI: 34–62%), 41% (95% UI: 28–55%), and 41% (95% UI: 27–56%) respectively. Change of age-standardised rates of incidence, death and DALYs were increased by 11% (95% UI: 1–21%), 6% (95% UI: − 3 to 16%), and 6% (95% UI: − 5 to 16%) respectively from 2010 to 2019. There were marked variations of burden of colorectal cancer at national level from 2010 to 2019 in Africa.
Conclusion
Increased age-standardised death rate and DALYs of colorectal cancer indicates low progress in CRC standard care-diagnosis and treatment, primary prevention of modifiable risk factors and implementation of secondary prevention modality. This serious effect would be due to poor cancer infrastructure and policy, low workforce capacity, cancer center for diagnosis and treatment, low finical security and low of universal health coverage in Africa.
Evaluating the impact of neurosurgical rotation experience in Africa on the interest and perception of medical students towards a career in neurosurgery: a protocol for a continental, cross-sectional study
Introduction
Africa has the second highest neurosurgical workforce deficit globally. Despite the many recent advancements in increasing neurosurgical access in Africa, published reports have shown that the vast majority of undergraduate students have little or no exposure to neurosurgery. The lack of exposure may pose a challenge in reducing the neurosurgical workforce deficit, which is one of the long-term strategies of tackling the unmet burden of disease. Students may also miss the opportunity to appreciate the specialty and its demands as well as nurture their interest in the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery.
Methods
The cross-sectional study will be conducted through the dissemination of a self-administered e-survey hosted on Google Forms from 21st February 2021 to 20th March 2021. The survey will contain five-point Likert scale, multiple-choice and free-text questions. The structured questionnaire will have four sections with 27 items: (i) socio-demographic background, (ii) neurosurgical experience, (iii) perception towards a neurosurgical career and (iv) interest in a neurosurgical career. All consenting medical students in African medical schools who are in their clinical years (defined as fourth to sixth years or higher years of study) will be eligible. Odds ratios and their 95% confidence intervals, Wilcoxon rank-sum test, Welch t-test and adjusted logistic regression models will be used to test for associations between independent and dependent variables. Statistical significance will be accepted at P < 0.05.
Paediatric anaesthesia care in Africa: challenges and opportunities
In 2015, the World Health Organization and member states recognised surgery and anaesthesia care as a component of universal health coverage, yet 1.7 billion children and adolescents continue to lack access to safe surgical care. An overwhelming proportion of these children are from low- and middle-income countries (LMICs).1,2 In Africa, where almost 50% of the population is under the age of 15, children are disproportionately affected. Without sustained global efforts, these inequities and injustices will persist.1 Findings from previous studies suggest a 10–100 times increase in paediatric perioperative mortality in children in LMICs as compared to high-income countries (HICs).3,4 While pieces of the puzzle may be missing, it is clear that not only is access a problem, but also the safety and quality of the perioperative care provided is of concern.
Feasibility of delivering foot and ankle surgical courses in a partnership in Eastern, Central and Sothern Africa
Foot and ankle pathology if not treated appropriately and in a timely manner can adversely affect both disability and quality adjusted life years. More so in the low- and middle-income countries where ambulation is the predominant means of getting around for the majority of the population in order to earn a livelihood. This has necessitated the equipping of the new generation of orthopaedic surgeons with the expertise and skills set to manage these conditions. To address this need, surgeons from the British Orthopaedic Foot & Ankle Society (BOFAS) and College of Surgeons of Eastern, Central and Southern Africa (COSECSA) transferred the “Principles of Foot and Ankle Surgery” course to an African regional setting. The course was offered to surgical trainees from 14-member countries of the COSECSA region and previously in the UK. The faculty was drawn from practicing surgeons experienced in both surgical education and foot and ankle surgery. The course comprises didactic lectures, case-based discussions in small groups, patient evaluations and guided surgical dissections on human cadavers. It was offered free to all participants. The feasibility of the course was evaluated using the model defined by Bowen considering the eight facets of acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. At the end of the course participants were expected to give verbal subjective feedback and objective feedback using a cloud based digital feedback questionnaire. The course content was evaluated by the participants as “Poor”, “Below average”, “Average”, “Good” and “Excellent”, which was converted into a value from 1–5 for analysis. The non-parametric categorical data was analysed using the Two-sample Wilcoxon rank-sum (Mann–Whitney) test, and significance was considered to be p < 0.05.