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Abstract Background Malaria is a huge public health problem in Africa that is responsible for more than one million deaths annually. In line with the Roll Back Malaria initiative and the Abuja Declaration, Eritrea and other African countries have intensified their fight against malaria. This study examines the impact of Eritrea's Roll Back Malaria Programme: 2000–2004 and the effects and possible interactions between the public health interventions in use. Methods This study employed cross-sectional survey to collect data from households, community and health facilities on coverage and usage of Insecticide-Treated Nets (ITNs), Indoor Residual Spraying (IRS), larvicidal activities and malaria case management. Comparative data was obtained from a similar survey carried out in 2001. Data from the Health Management Information System (HMIS) and reports of the annual assessments by the National Malaria Control Programme was used to assess impact. Time series model (ARIMA) was used to assess association. Results In the period 2000–2004, approximately 874,000 ITNs were distributed and 13,109 health workers and community health agents were trained on malaria case management. In 2004, approximately 81% households owned at least one net, of which 73% were ITNs and 58.6% of children 0–5 years slept under a net. The proportion of malaria cases managed by community health agents rose from 50% in 1999 to 78% in 2004. IRS coverage increased with the combined amount of DDT and Malathion used rising from 6,444 kg, in 2000 to 43,491 kg, in 2004, increasing the population protected from 117,017 to 259,420. Drug resistance necessitated regimen change to chloroquine plus sulfadoxine-pyrimethamine. During the period, there was a steep decline in malaria morbidity and case fatality by 84% and 40% respectively. Malaria morbidity was strongly correlated to the numbers of ITNs distributed (β = -0.125, p < 0.005) and the amount (kg) of DDT and Malathion used for IRS (β = -2.352, p < 0.05). The correlation between malaria case fatality and ITNs, IRS, population protected and annual rainfall was not statistically significant. Conclusion Eritrea has within 5 years attained key Roll Back Malaria targets. ITNs and IRS contributed most to reducing malaria morbidity.

[This corrects the article DOI: 10.1371/journal.pone.0222651.].

BACKGROUND:Knowledge of antibiotic prescription practices in low- and middle-income countries is limited due to a lack of adequate surveillance systems. OBJECTIVE:To assess the prescription of antibiotics for the treatment of acute respiratory tract infections (ARIs) in primary care. METHOD:An explanatory sequential mixed-methods study was conducted in 4 private not-for-profit outreach clinics located in slum areas in Nairobi, Kenya. Claims data of patients who received healthcare between April 1 and December 27, 2016 were collected in real-time through a mobile telephone-based healthcare data and payment exchange platform (branded as M-TIBA). These data were used to calculate the percentage of ARIs for which antibiotics were prescribed. In-depth interviews were conducted among 12 clinicians and 17 patients to explain the quantitative results. RESULTS:A total of 49,098 individuals were registered onto the platform, which allowed them to access healthcare at the study clinics through M-TIBA. For 36,210 clinic visits by 21,913 patients, 45,706 diagnoses and 85,484 medication prescriptions were recorded. ARIs were the most common diagnoses (17,739; 38.8%), and antibiotics were the most frequently prescribed medications (21,870; 25.6%). For 78.5% (95% CI: 77.9%, 79.1%) of ARI diagnoses, antibiotics were prescribed, most commonly amoxicillin (45%; 95% CI: 44.1%, 45.8%). These relatively high levels of prescription were explained by high patient load, clinician and patient perceptions that clinicians should prescribe, lack of access to laboratory tests, offloading near-expiry drugs, absence of policy and surveillance, and the use of treatment guidelines that are not up-to-date. Clinicians in contrast reported to strictly follow the Kenyan treatment guidelines. CONCLUSION:This study showed successful quantification of antibiotic prescription and the prescribing pattern using real-world data collected through M-TIBA in private not-for-profit clinics in Nairobi.

BACKGROUND:Limited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya. METHODS:Pregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum. PROMs were collected via mobile surveys at three antenatal and two postnatal time points. Outcomes included incontinence, dyspareunia, mental health, breastfeeding and satisfaction with care. Hospitals reported morbidity and mortality. Descriptive statistics on maternal and child outcomes, survey completion and follow-up rates were calculated. RESULTS:In six months, 204 women were recruited: 50% of women returned for a second ante-natal care visit, 50% delivered at referral hospitals and 51% completed the postnatal visit. The completion rates for the five PROM surveys were highest at the first antenatal care visit (92%) and lowest in the postnatal care visit (38%). Data on depression, dyspareunia, fecal and urinary incontinence were successfully collected during the antenatal and postnatal period. At six weeks postpartum, 86% of women breastfeed exclusively. Most women that completed the survey were very satisfied with antenatal care (66%), delivery care (51%), and post-natal care (60%). CONCLUSION:We have demonstrated that it is feasible to use mobile technology to follow women throughout pregnancy, track their attendance to pre-natal and post-natal care visits and obtain data on PROM. This study demonstrates the potential of mobile technology to collect PROM in a low-resource setting. The data provide insight into the quality of maternal care services provided and will be used to identify and address gaps in access and provision of high quality care to pregnant women.

CONSAMS; consortia; new African medical schools; admissions; accreditation; research; interdependence

Abstract Background Intestinal parasitic infections are among the most common infections worldwide. Various epidemiological studies indicate that the prevalence of intestinal parasites is high especially in developing countries, although in many of these, the environmental risk factors have not been clearly elucidated. The objective of this study was to determine the risk of pathogenic intestinal parasites infections in Kisii Municipality. Methods Random sampling was used in the selection of the study samples. Stool parasitological profiles of food handlers were done by direct smear and formalin-ethyl acetate sedimentation method. Both vegetable and meat samples were examined for the presence of intestinal parasites. The storage and meat handling practices of the various butcheries were observed. Results Types of samples examined for occurrence of intestinal parasites includes, a total of 84 vegetable, 440 meat and 168 stool samples. Fifty five (65.5%) vegetable, 334 (75.9%) meat and 69 (41.1%) of the stool samples were found positive for intestinal parasites indicating a high overall risk (66.18%) for intestinal parasite infections. Of the parasites detected, the most common parasites infesting the foodstuffs and infecting the food handlers were Ascaris lumbricoides and Entamoeba histolytica. Parasites were significantly less likely to be present on meat that was refrigerated during display than meat that was displayed at ambient temperature. Conclusion There is a high risk of infection with intestinal parasites in the sampled Municipal markets. About half of the food handlers surveyed (41.1 %) at the Municipal Hospital had one or more parasitic infections. Furthermore, meat (65.5%) and vegetables (75.9%) sold at the Municipal market were found to be contaminated with parasites hence the inhabitants requires a need for education on food safety, good distribution practices and improvement on sanitary conditions.

The prevalence of osteoporosis in Sub-Saharan African (SSA) countries is low, however, as urbanization takes root, it is predicted that bone health will decrease dramatically. The bone health of the semi-nomadic Ovahimba people of Namibia was investigated in the context of urbanization and changes of the sociocultural environment. Furthermore, data on bone health in SSA countries is scarce; there exists no ethnic-specific reference group for people of black origin. Included in the study were 98 urban and rural living Ovahimba people. Quantitative ultrasound was performed, sunrise/sunset saliva cortisol concentrations was measured and a questionnaire was conducted. There was no significant difference in the QUS parameters, however, after adjustment for confounders, SOS and SI differed significantly. The saliva cortisol concentrations differed significantly. After adjustment for confounders, saliva cortisol was significantly negatively correlated to SOS (r= -0.27, p = 0.021) giving an indication for an association between cortisol concentration and QUS parameters. The urban group furthermore showed a nutritional transition. Even though the bone health of the Ovahimba is very good, first signs of the adverse effects of urbanization were detected. Beside changes of lifestyle, this may be attributed to an increased cortisol exposure of the Ovahimba people living in an urban environment due to an increased psychosocial stress.

Context: Diabetes mellitus is increasingly affecting Africa., Objective: Urbanization of the Ovahimba people in Namibia is associated with an increased prevalence of disorders of glucose metabolism, and may thus be attributed to changes of cortisol homeostasis., Design: A prospective, cross-sectional, diagnostic study was applied., Setting: The study was conducted in the field. Location of the Diabetes Epidemic: Africa and Namibia., Participants: Ovahimba people: group 1 "urban" n = 60, 42 females, 46.3 ± 11.3 years (town); group 2 "rural" n = 63, 44 females, 51.1 ± 12.0 years (seminomadic)., Interventions: oGTT, sunrise and sunset saliva cortisol, metabolic parameters, questionnaire., Main Outcome Measure: The prevalence of disorders of glucose metabolism (DM, IGT, IFT)., Results: The prevalence of disorders of glucose metabolism differed significantly: urban group n = 17(28.3%) vs rural group n = 8(12.7%) (P = 0.04). The saliva cortisol concentrations also differed significantly: sunrise 0.34 ± 0.18 vs 0.12 ± 0.15 μg/dL, sunset 0.18 ± 0.20 vs 0.07 ± 0.09 μg/dL, area under the curve 6.16 ± 3.48 vs 2.28 ± 2.56 μg/dL * 24 h (all P < 0.001). Further metabolic parameters were unfavorably changed in the urban group: hip circumference (P < 0.001), waist circumference (P < 0.001), body mass index (P = 0.014), systolic BP at rest (P < 0.001), diastolic BP at rest (P = 0.002), systolic BP after exercise (P < 0.001), heart rate after exercise (P = 0.007), fasting glucose (P < 0.001), 2-h-glucose by OGTT (P = 0.002), triglycerides (P = 0.04), HDL-cholesterol (P = 0.014), prevalence of the metabolic syndrome (P < 0.001). Physical activity was higher in the rural group, and intake of fast food and sweets were higher in the urban group., Conclusions: Urbanization of the Ovahimba people is associated with an increasing prevalence of disorders of glucose metabolism and other unfavorable metabolic parameters. Besides changes of lifestyle, this may be attributed to an increased cortisol exposure of the Ovahimba people living in an urban environment.

The prevalence of noncommunicable diseases in Eritrea is increasing. Tobacco use is a recognized risk factor for most of these diseases, especially cardiovascular disease. No data have been published on tobacco use in Eritrea. The present study sought to establish the prevalence of tobacco smoking in Eritrea. The World Health Organization STEPwise approach was used for the survey, conducted in 2004 on a random national sample size of 2,460 subjects (response rate = 93.7%). The prevalence of tobacco smoking in the general population was 8.1%; the prevalence was 15% among men, compared with 0.6% among women. Prevalence rates were higher in those older than 45 years of age. The prevalence of tobacco smoking was higher among Muslims (11.4%) than Orthodox Christians (5.8%), and among alcohol drinkers (10.2%) than nondrinkers (6.6%). The majority of tobacco users (89.3%) used commercially available cigarettes. A study on knowledge, attitudes, and practices regarding tobacco use is needed to determine the behavioral factors leading to tobacco smoking among the vulnerable groups.

Background: High morbidity and mortality from malaria in Africa prompted the Abuja Declaration by African Heads of State in 2000. The goal set in the declaration for 2010 was to reduce malaria mortality by 50%. Countries were therefore expected to ensure that 60% of people suffering from malaria had access to treatment, that 60% of those at risk received intermittent prophylaxis, and that 60% of people in high-risk groups were using insecticide-treated nets (ITNs) by 2005. In 1999 Eritrea introduced malaria policies, strategies and multi-level interventions targeting households, communities and health facilities., Objectives: To assess Eritrea's progress towards meeting the Abuja Declaration goal, targets and key determinants., Methods: A retrospective study was undertaken using data from the Health Management Information System (HMIS) and reports of annual reviews. Correlation and regression analysis were used to assess associations between selected variables., Results: The incidence rate for malaria decreased from 6000/100000 in 1998 to 1100/100000 in 2003, representing > 80% decline in morbidity. The cumulative number of ITNs distributed increased from 50000 in 1998 to 685000 in 2003. The ITN impregnation rate increased from 15% to > 70% during the same period. Indoor residual spraying increased from 7444 kg to 41157 kg of insecticide in 2004 resulting in the protected population increasing from 117017 to 244315 respectively. The number of health workers recruited and trained rose from 936 to 4118. There was a strong correlation between the malaria incidence rate, distribution of ITNs (R2 = 0.76) and the total number of health workers trained (R2 = 0.72). The association was consistent in regression analysis (beta = -0.05, p = 0.03 for ITNs, and beta = -0.249, p = 0.05 for trained health workers)., Conclusion: Within 5 years Eritrea met the Abuja Declaration objectives through multiple vector-control methods, case management and surveillance.

The disease burden from noncommunicable diseases (NCDs) in Africa is rapidly increasing based on projections from a limited number of reports. In the absence of national health surveys in Zimbabwe, all data nationally generated between 1990 and 1997 were analyzed. From 1990 to 1997, prevalence rates (expressed per 100,000 people) of hypertension increased from 1000 to 4000, rates of diabetes increased from 150 to 550, and rates of cerebrovascular accidents (CVA) increased from 5 to 15. The case fatality rate (CFR) for CVA decreased substantially during the period of study, implying improved case management of the disease, while the CFR for most other diseases did not change significantly throughout the study period. The observation of increased prevalence of some NCDs during the study period was corroborated by findings from a blood pressure survey subsequently conducted in an urban environment of Zimbabwe, which revealed a hypertension (blood pressure > or =140/90 mm Hg) prevalence of 35% in women and 24% in men. In spite of the limitations of the centrally generated hospital-based data, its analysis is still valuable. Countries are therefore encouraged to utilize this easily accessible resource for policy formulation and resource mobilization.

The World Health Organization Regional Office for Africa (WHO AFRO) commissioned a study to compile and analyze published reports on non-communicable diseases (NCDs) in Africa to build evidence on the burden of NCDs in the region. Anecdotally, little information or literature was available on this subject. The objective of the study was to establish the status of NCDs in Africa by using published sources of information. A literature search was done through MEDLINE/PubMed and Google to identify studies that reported on prevalence rates of NCD risk factors. The study confirmed that information on NCDs in Africa was lacking. The prevalence of hypertension was found to be rapidly increasing, from 3% in rural areas to > 30% in some urban settings. In some populations, hypertension prevalence rates were higher in women than in men while the opposite was true in others. Most people with hypertension were not aware of their condition, and of those who were on treatment, < 20% had optimal control. The prevalence of diabetes mirrored that of hypertension, from < 1% in some rural areas to > 20% in some selected populations and racial groupings in urban settings. The predominant type was type 2 diabetes, which accounted for > 80% of all cases in some reports and tended to present later in life. The prevalence of tobacco smoking also varied across the continent, from < 1% in rural women to 50% in some urban men. Recent studies based on analysis of hospital-based information have documented NCD trends that were similar to prevalence data generated from national risk factor surveys. NCD risk factors such as hypertension and diabetes are increasing in Africa.

Objectives: The study examined the factors associated with recurrent cholera epidemics in Kano State of Northern Nigeria, the management of the epidemics and health outcomes., Methods: Using epidemiological data from the Public Health Department of the Kano State Ministry of Health, the study examined the frequency and geographical distribution of the epidemics for the period 1995 to 2001; procedures for detection; control measures as well as results of biological and bacteriological testing of water from different sources. Mapping and testing for significance of faecal contamination of water sources were done., Results: The number of cholera cases in the city was 2 630; 847 and 2 347 in 1995/6, 1997 and 1999 respectively. The State Epidemiological Unit which is responsible for surveillance detected epidemics using set thresholds and activated multi-sectoral emergency responses. Control measures encompassed accurate diagnosis at the reference laboratory, Kaduna; registration of cases; case management and public health measures targeting personal hygiene and water treatment. The cholera epidemics attracted worldwide attention with emergency responses from many agencies including WHO, UNICEF and Medicens Sand Frontiers (MSF). Case fatality rates decreased from 15% in 1995/6 to 5% in 1997 and 2% in 1999. The organism responsible for all the outbreaks was Vibrio cholerae, el-tor of inaba serotype. Water contamination of all sources was the principal cause of the epidemics. There were statistically significant differences in levels of faecal contamination of water sources, wells being most affected, followed by piped water, chi2 = 11.556, (p < 0.02). Bore holes were relatively safer sources of water. Point source epidemics always started from Kano City before fanning out to the rest of the State., Conclusion: Multi-sectoral Epidemic Preparedness and Response (EPR) approaches have contributed to the reduction in case fatality rates over the years and should be sustained. However, in order to prevent future cholera epidemics, there is need to introduce intervention measures that address the root problems of poor sanitation and unsafe water supplies.

Representatives from the Ministry of Health, the University of Nairobi and the Kenya Medical Association arranged a workshop in Nairobi in September, 1987 to ensure that policy makers, civil servants, academics and senior members of the medical profession would feel fully informed about the purpose and nature of distance learning. A further meeting was arranged for the supervisors and tutors who would be involved in the pilot project which was designed to validate the usefulness of distance learning materials prepared in London and to evaluate the organisational and educational aspects of the local system for distance learning. Ten rural medical officers, selected by the Ministry, met to be inducted at a briefing workshop in Mombasa. The medical officers were invited to study with three modules at their place of work during a period of six months and to complete a field project during the next six months. They were asked to keep a dairy, to use a notebook for critical comments on each module, and to complete two questionnaires. Their pre-test performance was compared with post-test performance. The results were analysed with a view to improving the modules and the local distance learning system.

Dramatic changes have occurred in society since the Second World War. These include great advances in science and medicine. Such changes are likely to continue at an ever increasing rate. The changes and possible implications for health care delivery over the next fifty years are discussed. These changes and their potential implications place special demands on doctors since many will still be in active practice well into the next century. To meet the challenge doctors will need to adapt to and participate in change. Continuing medical education should, therefore, aim to assist doctors to adapt to and participate in change.