Showing papers by "Mohamed F Jalloh published in 2020"
TL;DR: Barriers to accessing MHS during the EVD outbreak in West Africa were influenced by complex but inter-related factors at the individual, interpersonal, health system and international level.
Abstract: Introduction The Ebola virus disease (EVD) outbreak in West Africa, affecting Guinea, Liberia and Sierra Leone from 2014 to 2016, was a substantial public health crisis with health impacts extending past EVD itself. Access to maternal health services (MHS) was disrupted during the epidemic, with reductions in antenatal care, facility-based deliveries and postnatal care. We aimed to identify and describe barriers related to the uptake and provision of MHS during the 2014–2016 EVD outbreak in West Africa. Methods In June 2020, we conducted a scoping review of peer-reviewed publications and grey literature from relevant stakeholder organisations. Search terms were generated to identify literature that explained underlying access barriers to MHS. Published literature in scientific journals was first searched and extracted from PubMed and Web of Science databases for the period between 1 January 2014 and 27 June 2020. We hand-searched relevant stakeholder websites. A ‘snowball’ approach was used to identify relevant sources uncaptured in the systematic search. The identified literature was examined to synthesise themes using an existing framework. Results Nineteen papers were included, with 26 barriers to MHS uptake and provision identified. Three themes emerged: (1) fear and mistrust, (2) health system and service constraints, and (3) poor communication. Our analysis of the literature indicates that fear, experienced by both service users and providers, was the most recurring barrier to MHS. Constrained health systems negatively impacted MHS on the supply side. Poor communication and inadequately coordinated training efforts disallowed competent provision of MHS. Conclusions Barriers to accessing MHS during the EVD outbreak in West Africa were influenced by complex but inter-related factors at the individual, interpersonal, health system and international level. Future responses to EVD outbreaks need to address underlying reasons for fear and mistrust between patients and providers, and ensure MHS are adequately equipped both routinely and during crises.
34 citations
TL;DR: Analysis of the Community Led Ebola Action approach implemented through the Social Mobilization Action Consortium during the 2014–2016 Ebola epidemic in Sierra Leone demonstrates how large-scale, coordinated community engagement interventions can be achieved and monitored in real-time during future Ebola epidemics and other similar epidemics.
Abstract: Documentation of structured community engagement initiatives and real-time monitoring of community engagement activities during large-scale epidemics is limited. To inform such initiatives, this paper analyses the Community Led Ebola Action (CLEA) approach implemented through the Social Mobilization Action Consortium (SMAC) during the 2014-2016 Ebola epidemic in Sierra Leone. The SMAC initiative consisted of a network of 2466 community mobilisers, >6000 religious leaders and 42 local radio stations across all 14 districts of Sierra Leone. Community mobilisers were active in nearly 70% of all communities across the country using the CLEA approach to facilitate community analysis, trigger collective action planning and maintain community action plans over time. CLEA was complemented by interactive radio programming and intensified religious leader engagement.Community mobilisers trained in the CLEA approach used participatory methods, comprised of an initial community 'triggering' event, action plan development and weekly follow-ups to monitor progress on identified action items. Mobilisers collected operational and behavioural data on a weekly basis as part of CLEA. We conducted a retrospective analysis of >50 000 weekly reports from approximately 12 000 communities from December 2014 to September 2015. The data showed that 100% of the communities that were engaged had one or more action plans in place. Out of the 63 110 cumulative action points monitored by community mobilisers, 92% were marked as 'in-progress' (85%) or 'achieved' (7%) within 9 months. A qualitative examination of action points revealed that the in-progress status was indicative of the long-term sustainability of most action points (eg, continuous monitoring of visitors into the community) versus one-off action items that were marked as achieved (eg, initial installation of handwashing station). Analysis of behavioural outcomes of the intervention indicate an increase over time in the fraction of reported safe burials and fraction of reported cases referred for medical care within 24 hours of symptom onset in the communities that were engaged.Through CLEA, we have demonstrated how large-scale, coordinated community engagement interventions can be achieved and monitored in real-time during future Ebola epidemics and other similar epidemics. The SMAC initiative provides a practical model for the design, implementation and monitoring of community engagement, integration and coordination of community engagement interventions with other health emergency response pillars, and adaptive strategies for large-scale community-based operational data collection.
31 citations
TL;DR: This commentary synthesizes illustrative evidence on successful social mobilization efforts promoting the uptake of immunization services in select low- and middle-income countries and critically examines recurring challenges faced when implementing social mobilization for immunization in LMICs.
Abstract: Creating and sustaining demand for immunization services is a global priority to ensure that vaccine-eligible populations are fully protected from vaccine-preventable diseases. Social mobilization ...
22 citations
TL;DR: A review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines and regarding the lack of endourological equipment and expertise, most urological centers in these regions still consider open surgery for kidney and ureteral stones.
Abstract: Urolithiasis is a global pathology with increasing prevalence rate The lifetime recurrence of urolithiasis ranges from 10-75% creating a public health crisis in affected regions The epidemiology of urolithiasis in most parts of Africa and Asia remains poorly documented as incidence and prevalence rates in these settings are extrapolated from hospital admissions The surgical management of kidney and ureteral stones is based on the stone location, size, the patient's preference and the institutional capacity To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy However, regarding the lack of endourological equipment and expertise in most parts of Sub-Saharan Africa (SSA), most urological centers in these regions still consider open surgery for kidney and ureteral stones This review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines
21 citations
TL;DR: Community-based development of locally feasible, locally owned action plans, with the support of community mobilisers, has potential to address unmet needs for more sustained behaviour change in outbreak settings.
20 citations
TL;DR: The results illustrate the complexity of how individuals perceived their Ebola acquisition risk based on the way they received information, what they knew about Ebola, and actions they took to protect themselves.
Abstract: Perceived susceptibility to a disease threat (risk perception) can influence protective behaviour. This study aims to determine how exposure to information sources, knowledge and behaviours potentially influenced risk perceptions during the 2014–2015 Ebola Virus Disease outbreak in Sierra Leone. The study is based on three cross-sectional, national surveys (August 2014, n = 1413; October 2014, n = 2086; December 2014, n = 3540) that measured Ebola-related knowledge, attitudes, and practices in Sierra Leone. Data were pooled and composite variables were created for knowledge, misconceptions and three Ebola-specific behaviours. Risk perception was measured using a Likert-item and dichotomised into ‘no risk perception’ and ‘some risk perception’. Exposure to five information sources was dichotomised into a binary variable for exposed and unexposed. Multilevel logistic regression models were fitted to examine various associations. Exposure to new media (e.g. internet) and community-level information sources (e.g. religious leaders) were positively associated with expressing risk perception. Ebola-specific knowledge and hand washing were positively associated with expressing risk perception (Adjusted OR [AOR] 1.4, 95% Confidence Interval [CI] 1.2–1.8 and AOR 1.4, 95% CI 1.1–1.7 respectively), whereas misconceptions and avoiding burials were negatively associated with risk perception, (AOR 0.7, 95% CI 0.6–0.8 and AOR 0.8, 95% CI 06–1.0, respectively). Our results illustrate the complexity of how individuals perceived their Ebola acquisition risk based on the way they received information, what they knew about Ebola, and actions they took to protect themselves. Community-level information sources may help to align the public’s perceived risk with their actual epidemiological risk. As part of global health security efforts, increased investments are needed for community-level engagements that allow for two-way communication during health emergencies.
12 citations
TL;DR: To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary.
Abstract: Meningococcal serogroup A conjugate vaccine (MACV) was introduced in 2017 into the routine childhood immunization schedule (at 15–18 months of age) in Burkina Faso to help reduce meningococcal meningitis burden. MACV was scheduled to be co-administered with the second dose of measles-containing vaccine (MCV2), a vaccine already in the national schedule. One year following the introduction of MACV, an assessment was conducted to qualitatively examine health workers’ perceptions of MACV introduction, identify barriers to uptake, and explore opportunities to improve coverage. Twelve in-depth interviews were conducted with different cadres of health workers in four purposively selected districts in Burkina Faso. Districts were selected to include urban and rural areas as well as high and low MCV2 coverage areas. Respondents included health workers at the following levels: regional health managers (n = 4), district health managers (n = 4), and frontline healthcare providers (n = 4). All interviews were recorded, transcribed, and thematically analyzed using qualitative content analysis. Four themes emerged around supply and health systems barriers, demand-related barriers, specific challenges related to MACV and MCV2 co-administration, and motivations and efforts to improve vaccination coverage. Supply and health systems barriers included aging cold chain equipment, staff shortages, overworked and poorly trained staff, insufficient supplies and financial resources, and challenges with implementing community outreach activities. Health workers largely viewed MACV introduction as a source of motivation for caregivers to bring their children for the 15- to 18-month visit. However, they also pointed to demand barriers, including cultural practices that sometimes discourage vaccination, misconceptions about vaccines, and religious beliefs. Challenges in co-administering MACV and MCV2 were mainly related to reluctance among health workers to open multi-dose vials unless enough children were present to avoid wastage. To improve effective administration of vaccines in the second-year of life, adequate operational and programmatic planning, training, communication, and monitoring are necessary. Moreover, clear policy communication is needed to help ensure that health workers do not refrain from opening multi-dose vials for small numbers of children.
10 citations
TL;DR: The prognosis of testicular tumor is good with remarkable chemosensitivity to cisplatin-based regimen and results are achievable in the sub-Saharan region if the relevant resources are appropriated for cancer care and clinical guidelines are formulated in a regional context.
Abstract: Testicular cancer is a common malignancy in young males with higher incidence in developed nations but with the lowest incidence in Africa (0.3-0.6/100 000). Ironically, the global testicular cancer mortality rate has shown a reverse trend to its incidence with higher rates in low- and middle-income countries (0.5 per 100 000) than in high-income countries. Data from GLOBOCAN 2008 have shown relatively high mortality rates in sub-Saharan countries like Mali, Ethiopia, Niger and Malawi. The prognosis of testicular tumor is good with remarkable chemosensitivity to cisplatin-based regimen. Early diagnosis, careful staging and a multidisciplinary management approach is crucial to achieve this optimal result. These results are achievable in the sub-Saharan region if the relevant resources are appropriated for cancer care and clinical guidelines are formulated in a regional context.
9 citations
TL;DR: There are some data to support the association between schistosomiasis and bladder cancer in sub-Saharan Africa, however, these have been limited by their design and may not sufficiently establish carcinogenesis.
Abstract: Background . Globally, approximately 20% of malignancy are caused by infection. Schistosoma infection is a major cause of bladder in most part of Africa. In 2018 alone, there were approximately 549,393 new cases and 199,922 deaths from bladder cancer. The presence of Schistosoma ova in the venous plexus of the bladder induces a cascade of inflammation causing significant tissue damage and granulomatous changes. Methodology. A literature review was conducted from 1995 to 2019 using PubMed, Google Scholar, African Journal Online, and Google databases. Relevant data on the association of "Schistosomiasis and Bladder cancer" in sub-Saharan Africa (SSA) were retrieved. Evidence Synthesis. Results from research using animal models to establish the carcinogenesis of Schistosoma and bladder cancer have been helpful but inconclusive. Immunoregulatory cytokines and genetic marker have been identified to play a role in the pathogenesis. In some parts of sub-Saharan Africa, there has been close association of squamous cell carcinoma and histological evidence of Schistosoma ova. Conclusion. There are some data to support the association between schistosomiasis and bladder cancer in sub-Saharan Africa. However, these have been limited by their design and may not sufficiently establish carcinogenesis. There is a need for more genomic and molecular research to better characterize S. haematobium and its effects on the bladder. Such goal will contribute immensely to Schistosoma bladder cancer prevention and control.
8 citations
TL;DR: Although vaccination coverage in slums was similar to non-slums, study findings support the need for targeted interventions to improve coverage, especially for the second dose of measles vaccine to avoid large scale measles outbreaks.
Abstract: Background Urban childhood immunization programs face unique challenges in access, utilization, and demand due to frequent population movement between and within localities, sprawling informal settlements, and population heterogeneity. We conducted a cross-sectional household survey in the Western Area Urban district, Sierra Leone, stratified by slums and non-slums as defined by the United Nations Development Program. Methods Based on data from child vaccination cards, weighted vaccination coverage was estimated from 450 children aged 12-36 months (household response rate = 83%). Interviews with 444 caregivers identified factors related to accessing routine immunization services. Factors associated with coverage in bivariate analyses were examined in multivariate models using backward stepwise procedure. Results Coverage was similar in slums and non-slums for 3-doses of diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine (86%, 92%) and second dose of measles vaccine (33%, 29%). In a multivariate logistic regression model, incomplete pentavalent vaccine coverage was associated with being second or later birth order (adjusted odds ratio (aOR) = 4.5 (95% confidence interval (CI) = 1.4-14.9), a household member not approving of childhood vaccinations (aOR = 7.55, 95% CI = 1.52-37.38), self-reported delay of child receiving recommended vaccinations (aOR = 4.8, 95% CI = 1.0-22.1), and living in a household made of natural or rudimentary materials (aOR = 3.5, 95% CI = 1.2-10.6). Overall, the majority (>70%) of caregivers reported occupation as petty trader and <50% reported receiving vaccination information via preferred communication sources. Conclusions Although vaccination coverage in slums was similar to non-slums, study findings support the need for targeted interventions to improve coverage, especially for the second dose of measles vaccine to avoid large scale measles outbreaks. Strategies should focus on educating household members via preferred communication channels regarding the importance of receiving childhood vaccinations on time for all offspring, not just the first born. Vaccination coverage could be further improved by increasing accessibility through innovative strategies such as increasing the number of vaccination days and modifying hours.
6 citations
TL;DR: Assessment of population-level protective caregiving intentions revealed that caregivers, who were mostly aware of the risk of transmission and general protective measures, felt constrained by different contextual factors and there was a perceived lack of practical advice.
Abstract: Introduction Caring for an Ebola patient is a known risk factor for disease transmission. In Sierra Leone during the outbreak in 2014/2015, isolation of patients in specialised facilities was not always immediately available and caring for a relative at home was sometimes the only alternative. This study sought to assess population-level protective caregiving intentions, to understand how families cared for their sick and to explore perceived barriers and facilitators influencing caregiving behaviours. Methods Data from a nationwide household survey conducted in December 2014 were used to assess intended protective behaviours if caring for a family member with suspected Ebola. Their association with socio-demographic variables, Ebola-specific knowledge and risk perception was analysed using multilevel logistic regression. To put the results into context, semi-structured interviews with caregivers were conducted in Freetown. Results Ebola-specific knowledge was positively associated with the intention to avoid touching a sick person and their bodily fluids (adjusted OR (AOR) 1.29; 95% CI 1.01 to 1.54) and the intention to take multiple protective measures (AOR 1.38; 95% CI 1.16 to 1.63). Compared with residing in the mostly urban Western Area, respondents from the initial epicentre of the outbreak (Eastern Province) had increased odds to avoid touching a sick person or their body fluids (AOR 4.74; 95% CI 2.55 to 8.81) and to take more than one protective measure (AOR 2.94; 95% CI 1.37 to 6.34). However, interviews revealed that caregivers, who were mostly aware of the risk of transmission and general protective measures, felt constrained by different contextual factors. Withholding care was not seen as an option and there was a perceived lack of practical advice. Conclusions Ebola outbreak responses need to take the sociocultural reality of caregiving and the availability of resources into account, offering adapted and acceptable practical advice. The necessity to care for a loved one when no alternatives exist should not be underestimated.
TL;DR: Although VaxTrac helped to shorten the time to manage, summarize, and report vaccination records, data sharing restrictions coupled with inconsistent and inefficient workflows were major implementation challenges.
TL;DR: The impact of education and training in international surgical partnerships on outcomes of urethral stricture disease in low- and middle-income countries is explored to encourage data collection and outcomes assessments to promote evidence-based and safe surgical care.
Abstract: To explore the impact of education and training in international surgical partnerships on outcomes of urethral stricture disease in low- and middle-income countries. To encourage data collection and outcomes assessments to promote evidence-based and safe surgical care. Qualitative data were collected through observation of a reconstructive surgical workshop held by IVUmed at a host site in Dakar, Senegal. Quantitative data were collected through a retrospective review of 11 years of hospital data to assess surgical outcomes of urethral stricture disease before and after IVUmed started reconstructive workshops at the site. In the 11-year study period, 569 patients underwent 774 surgical procedures for urethral strictures. The numbers and types of urethroplasty techniques increased after IVUmed started its workshops. The average number of urethroplasties increased from 10 to 18.75/year. There was a statistically significant improvement in the mean success rate of urethroplasties from 12.7% before to 29% after the workshops. Anastomotic urethroplasty success rates doubled from 16.7 to 35.1%, but this was not statistically significant (p = 0.07). The improved success rate was sustained in cases performed without an IVUmed provider. Urethral stricture disease treatment in low- and middle-income countries is fraught with challenges due to complex presentations and limited subspecialty training. Improper preoperative management, lack of specialty instruments, and suboptimal wound care all contribute to poor outcomes. International surgical groups like IVUmed who employ the “teach-the-teacher” model enhance local practitioner expertise and independence leading to long-term improvements in patient outcomes. Tailoring practice guidelines to the local resource framework and encouraging data collection and outcomes assessment are vital components of providing responsible care and should be encouraged.
TL;DR: In this article, the authors describe the design, deployment and implementation of a digital reporting system used in six high transmission districts in Sierra Leone during the 2014-2016 Ebola outbreak in 14 districts and highlight lessons learnt from their experience in scaling up the system during an unprecedented public health crisis.
Abstract: Community engagement and community-based surveillance are essential components of responding to infectious disease outbreaks, but real-time data reporting remains a challenge. In the 2014-2016 Ebola outbreak in Sierra Leone, the Social Mobilisation Action Consortium was formed to scale-up structured, data-driven community engagement. The consortium became operational across all 14 districts and supported an expansive network of 2500 community mobilisers, 6000 faith leaders and 42 partner radio stations. The benefit of a more agile digital reporting system became apparent within few months of implementing paper-based reporting given the need to rapidly use the data to inform the fast-evolving epidemic. In this paper, we aim to document the design, deployment and implementation of a digital reporting system used in six high transmission districts. We highlight lessons learnt from our experience in scaling up the digital reporting system during an unprecedented public health crisis. The lessons learnt from our experience in Sierra Leone have important implications for designing and implementing similar digital reporting systems for community engagement and community-based surveillance during public health emergencies.
TL;DR: The purpose of this study was to evaluate the role of simulation in the development of a center of excellence center in Senegal and found the quality of the control of hemostasis evaluated on a basic procedure and during a resection is significantly better in the expert group.
Abstract: Teaching of surgery has long relied on live practice. The advent of endo-urology and laparoscopy have favored the development of simulation. The purpose of this study was to evaluate the role of simulation in the development of a center of excellence center in Senegal. Simulation has become the standard for surgical training students in Europe and the USA, allowing for a better and faster learning. The routine practice of minimally invasive surgery in urology along with a high number of residents should favor the use of simulation in this setting. The experts achieved a higher percentage of prostate tissue resection within the allotted time for this procedure. The quality of the control of hemostasis evaluated on a basic procedure and during a resection is significantly better in the expert group. The satisfaction survey was conducted at the end of the seminar.
TL;DR: Additional descriptive data from the assessment of the VaxTrac EIR in Sierra Leone reveal patterns in the congruity of vaccine doses captured that have implications for policy and programmatic decisions regarding the use of Vax trac and other similar EIRs in low resource urban settings.
TL;DR: The epidemiological and etiopathogenic aspects of obstetric fistulas and the results of their management at the National Fistula Treatment Centre in N'Djamena (Chad) over a 4-year period were evaluated.
Abstract: The objective of our study was to report on the epidemiological and etiopathogenic aspects of obstetric fistulas and to evaluate the results of their management at the National Fistula Treatment Centre in N'Djamena (Chad). Patients and Methods: This was a retrospective, descriptive study conducted at the National Fistula Treatment Centre in N'Djamena over a 4-year period from January 2012 to December 2016. Results: The mean age of our patients was 26.38 years with extremes of 12 to 74 years. The majority of our patients were young women aged 12 to 22 years. Of the patients 82.5% resided in rural areas. They were housewives in 88.9% and victims of genital mutilation in 76.8%. 73.6% did not have a prenatal consultation. A vaginal delivery was recorded in 74.9%. Perinatal infant mortality was recorded in 83.2%. Spinal anaesthesia was used in 95.7% of cases. The repair by low way in 93.7%. The success rate in a so-called first-hand fistulas was noted in 88.88%. Conclusion: Obstetrical fistulas is a real public health problem in our countries. Women with fistula are victims of all forms of social exclusion. The most effective means of combating it remains prevention and access to emergency obstetric care.
TL;DR: This work highlights international organizations that have prioritized health system strengthening and long-term sustainability and applies the lessons learned to propose mechanisms for developing centers of excellence in low- and middle-income countries.
Abstract: As healthcare disparity gaps continue to grow across the globe, so too are the efforts aimed at addressing them. Here we review the most common platforms currently used in global health and advantages and disadvantages of each. We highlight international organizations that have prioritized health system strengthening and long-term sustainability and apply the lessons learned from these endeavors to propose mechanisms for developing centers of excellence in low- and middle-income countries. Health system strengthening must be prioritized in international urologic endeavors. Without recognizing this as a fundamental goal, well-intentioned efforts are bound to have only short-term benefit and suboptimal use of valuable resources and will neglect a critical opportunity to promote local self-sufficiency and sustainable improvement in patient outcomes.
01 Jan 2020
TL;DR: The case of an 82-year-old woman with a rare urinary bladder melanoma who presented with terminal hematuria, who refused to undergo chemotherapy or radiotherapy in medical oncology center, and died 5 months after the diagnosis.
Abstract: The authors report the case of an 82-year-old woman with a rare urinary bladder melanoma. She presented with terminal hematuria. Physical examination found bilateral inguinal lymphadenopathy. Ultrasound examination of the pelvis revealed a mass in the bladder. Urethroscopy revealed a dark-colored mass at the bladder neck. Histopathology of the biopsy showed primary melanoma of urinary bladder. Thoracoabdominal computed tomography found a lumbar vertebral metastasis. She refused to undergo chemotherapy or radiotherapy in medical oncology center. The patient died 5 months after the diagnosis. The epidemiology, diagnosis, prognosis, and disease management aspects are discussed through a review of the literature.