Pan African Medical Journal最新文献

Introduction: the Expanded Programme on Immunization, initiated by the World Health Organization in 1974, has significantly improved global health by providing equitable access to life-saving vaccines. Despite these achievements, the COVID-19 pandemic caused setbacks in immunization coverage. The Big Catch-Up initiative, launched in April 2023, aims to restore immunization levels by targeting zero-dose and under-immunized children. This study examines BCU integration with routine immunization activities in Tanzania, focusing on the operational dimensions of catch-up efforts, challenges and enabling factors.

Methods: a comprehensive EPI review was conducted in November 2024, incorporating catch-up efforts alongside routine immunization components. Structured BCU questionnaires were developed for four levels of the health system: national, regional, district, and health facility personnel. Data collection involved 66 key informant interviews across various geographic areas. Thematic analysis was used to code and analyze qualitative data, utilizing DelveTool for data management and analysis.

Results: Tanzania's early roll-out of the BCU initiative, combined with polio and measles outbreak responses, demonstrated a proactive approach to addressing immunization gaps. Key strengths included well-articulated goals and targets, catch-up vaccination policy availability, and community engagement. Challenges included limited policy dissemination at lower levels, inconsistent recording practices, and staff shortages. Routinization of catch-up vaccination and capacity-building programmes was identified as essential for sustaining immunization efforts.

Conclusion: integration of catch-up strategies into routine immunization activities and the proactive approach of the Tanzanian government were key success factors. Structured policy dissemination, robust data management systems, and capacity-building programmes are crucial for demonstrating results, sustaining and expanding immunization efforts.

In 2024, mpox was declared a public health emergency. Several response measures have since been implemented by health authorities in the affected countries to control the outbreak. Our perspective was triggered by an article in the special issue on the surge of mpox in Africa that highlighted rashless or non-exanthematous presentations of mpox in Nigeria. Although these have been previously highlighted, especially during the global outbreak in 2022, the contribution of these factors to the general outbreak dynamics remains poorly understood. We reflect on the possible implications of this outbreak and strategies to address it in the context of a newer clade 1b responsible for the current upsurge, where no prevalence studies of rashless mpox have been done. Using our experiences, we also discuss how diagnostic expectations centred on the presence of rash may hinder timely detection, response, and reporting. Moreover, current outbreak situation reports do not disaggregate cases by symptom profile (for example, rash-presenting versus rashless), a gap that undermines a comprehensive understanding of the actual burden of mpox. Finally, we analyse the potential implications of undetected spread, surveillance, vaccination strategies and risk communication and behavioural change practices, to help break the chains of transmission that might have been missed.

Introduction: Non-Communicable Diseases (NCDs) pose a serious global health challenge. The burden of NCDs affects individuals across various demographic categories. Socioeconomic status (SES) has long been recognized as a determinant of health outcomes. Previous research suggests a complex interplay between SES and NCDs, with disparities in prevalence and disease management observed across different socioeconomic strata. This study aims to further examine the association between NCDs and socioeconomic characteristics to inform evidence-based interventions that can effectively mitigate the burden of NCDs.

Methods: this study was a secondary analysis of a cross-sectional dataset collected in 2021 by the Tanzanian National Institute for Medical Research (NIMR). The original study assessed willingness and ability to pay for medical insurance. The current study employed quantitative approaches. Logistic regression is used to assess the association between SES and NCDs, adjusting for potential confounders including age, gender, family size, health insurance status, and place of residence. A backward elimination approach was used to retain variables with p < 0.2 in the final model. Socioeconomic status was assessed using an asset index generated through principal component analysis.

Results: a total of 3,566 households were analyzed, with a mean age of 38.04 (SD: 11.76), 53.7% of whom were male. The overall prevalence of NCDs was 12.9%. Households in lower SES quintiles had higher NCD prevalence than those in higher SES quintiles, although this association was not statistically significant after adjustment. However, age, larger family size, and lack of health insurance remained statistically significant predictors of NCD prevalence.

Conclusion: while a clear association was observed between lower SES and NCDs in the univariate analysis, this relationship lost statistical significance after adjusting for demographic and household characteristics. However, age, family size, and lack of health insurance remained significant predictors of NCD prevalence.

Bisalbuminemia is a rare qualitative anomaly characterized by the occurrence of two distinct albumin bands or a single widened albumin band on serum protein electrophoresis, reflecting the presence of a normal albumin and a modified albumin in the same individual. It can be hereditary or acquired and transient, with physiopathological mechanisms that remain poorly understood. This study presents three cases of bisalbuminemia observed at the Biochemistry Laboratory of the Mohammed VI University Hospital in Oujda. Electrophoresis results showed that all reported cases were acquired and transient. Three major causes of pseudo-bisalbuminemia were identified: administration of beta-lactam antibiotics, nephrotic syndrome, and exacerbations of chronic pancreatitis. Additionally, in light of other reported cases, we here discuss the main genetic and acquired causes of this condition.

The WHO (World Health Organization) African Region measles/rubella laboratory network was established to provide support to the measles/rubella elimination program. From the official designation of a laboratory to the provision of basic equipment and training, regular laboratory assessment, the network has been functioning for more than 21 years in a standardized manner. We analyzed the performance of the laboratory network in the Western Africa Subregion. The comparison of the period 2004-2013 versus the period 2014-2024 shows an increase in the average number of functioning laboratories, specimens received /tested and onsite accreditation reviews conducted. The overall timeliness in sending out IgM results to EPI/national level remains above the expected target. Quarterly confirmatory testing for serology is implemented by most of the laboratories. More than 92% of the laboratories have obtained a passing score for annual serology Proficiency Test. With the molecular tests taking place in laboratories that have passed the molecular external quality assurance test, measles B3 genotypes were identified in 11 countries of the sub-Region over the past 21 years. As of today, the measles and rubella laboratory network in West Africa continues to operate despite the various challenges faced.

Introduction: prostate cancer is reported in 16.7% of benign prostate hyperplasia (BPH) surgical specimens. This incidental prostate cancer (IPCa) is usually low grade. While incidence rates vary widely across regions, no published data exist from Rwanda, thus motivating this study.

Methods: this was a retrospective cross-sectional analysis of Trans-Urethral Resection of Prostate (TURP) and open simple prostatectomy specimens from two tertiary hospitals between January 2015 and October 2022 to identify IPCa rate. The clinical characteristics and pathology reports were retrieved. Independent t-test, Fisher´s exact test, and logistic regression were performed to assess associations between clinical characteristics and occurrence of IPCa.

Results: we included 153 patients, mean age 70 years (SD: ±10). 140/153 patients had Lower Urinary Tract Symptoms (LUTS), macrohematuria 4/153, and low back pain 1/153. IPCa was diagnosed in six individuals (6/153, 4%). One patient (1/6) with hematuria and the sole patient with low back pain had IPCa diagnosis (respectively OR: 16.4, 95% CI: 1.1 - 235.9, P=0.04 and OR 38.8, 95% CI: 1.5 - 881.2, P=0.02). Age, prostate volume, and a PSA >4ng/mL were not predictors of IPCa. Grade group (GG) 2 had 2/6 patients, while GG 1, 3, 4, and 5 had 1/6 each. Clinically, 1/6 were cT1a, 5/6 cT1b, with one patient upstaged to T3b postoperatively. Cancer management was watchful waiting in 2/6, active surveillance in 1/6, and androgen deprivation therapy in 3/6 patients.

Conclusion: the incidence of prostate cancer in BPH specimens may be low but occasionally high-grade. Patients with symptoms beyond LUTS need careful assessment preoperatively. Larger prospective studies are needed to corroborate these findings for clinical use.