Muhammad Kabir Musa, Gibert Eshun, Mohamed Abdul Kareem Adam Modber, Usman Abubakar Haruna, Abdullateef Abdulsalam, Asma'u Shuaibu Zailani, Farida Zakariya, Nuruddeen Abubakar Adamu, M. B. Musa, Godness K Biney
Sudan, a country located in northeastern Africa, is grappling with a profound health crisis resulting from the recent war that erupted on April 15, 2023. This conflict has inflicted significant damage on the country's health system, particularly through the destruction of healthcare infrastructure. Approximately 61% of health facilities have been destroyed, leaving only 16% operating optimally in Khartoum. Hospitals and clinics, vital for public health, have become targets of violence, exacerbating the challenges faced by the nation. The World Health Organization has noted the closure of roughly 16 hospitals since the start of the conflicts due to staff safety concerns as well as a shortage of hospital supplies, consumables, and medication. There has also been a gradual waning of donor support and resources allocated to address protracted crises and emergencies worldwide Sudan receives very little funding from donor organizations to maintain its healthcare system, which worsens the nation's general public health architecture. This makes the country vulnerable to serious challenges like disease outbreaks, starvation, infectious diseases, deteriorating health infrastructure, and mental health issues. To successfully reduce the severity of negative impacts on public health, the crisis must be ceased and facilities reopened. An emergency disease surveillance system for infectious diseases should be established, women and child health should be prioritized, and mental health awareness programs and services should be implemented. The global community must support the efforts to mitigate the devastating effects of this crisis. This article aims to highlight the critical impact of the recent war on Sudan's healthcare, advocating for urgent measures, including facility reopening, disease surveillance, and global support to mitigate devastating consequences.
{"title":"Public health consequences of armed conflict in Sudan in the face of global donor fatigue","authors":"Muhammad Kabir Musa, Gibert Eshun, Mohamed Abdul Kareem Adam Modber, Usman Abubakar Haruna, Abdullateef Abdulsalam, Asma'u Shuaibu Zailani, Farida Zakariya, Nuruddeen Abubakar Adamu, M. B. Musa, Godness K Biney","doi":"10.1002/puh2.156","DOIUrl":"https://doi.org/10.1002/puh2.156","url":null,"abstract":"Sudan, a country located in northeastern Africa, is grappling with a profound health crisis resulting from the recent war that erupted on April 15, 2023. This conflict has inflicted significant damage on the country's health system, particularly through the destruction of healthcare infrastructure. Approximately 61% of health facilities have been destroyed, leaving only 16% operating optimally in Khartoum. Hospitals and clinics, vital for public health, have become targets of violence, exacerbating the challenges faced by the nation. The World Health Organization has noted the closure of roughly 16 hospitals since the start of the conflicts due to staff safety concerns as well as a shortage of hospital supplies, consumables, and medication. There has also been a gradual waning of donor support and resources allocated to address protracted crises and emergencies worldwide Sudan receives very little funding from donor organizations to maintain its healthcare system, which worsens the nation's general public health architecture. This makes the country vulnerable to serious challenges like disease outbreaks, starvation, infectious diseases, deteriorating health infrastructure, and mental health issues. To successfully reduce the severity of negative impacts on public health, the crisis must be ceased and facilities reopened. An emergency disease surveillance system for infectious diseases should be established, women and child health should be prioritized, and mental health awareness programs and services should be implemented. The global community must support the efforts to mitigate the devastating effects of this crisis. This article aims to highlight the critical impact of the recent war on Sudan's healthcare, advocating for urgent measures, including facility reopening, disease surveillance, and global support to mitigate devastating consequences.","PeriodicalId":506750,"journal":{"name":"Public Health Challenges","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140480941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pelden Chejor, T. Dorji, Ngawang Dema, Andrew Stafford
Approximately 2 billion people globally have limited access to essential medicines, particularly those living in low‐ and middle‐income countries (LMICs). In addition, there is a higher prevalence of substandard and counterfeit medicines in LMICs, which may cause antimicrobial resistance and therapeutic failure. Good manufacturing practice (GMP) is key to ensuring access to high‐quality, safe and effective medicines, including active pharmaceutical ingredients and excipients used for manufacturing finished dosage forms. Compliance with GMP standards saves resources for both manufacturers (e.g. avoiding expensive product recalls) and governments (e.g. minimising compliance inspections). Concerted collaborations among different countries to harmonise GMP standards and procedures have occurred, and the World Health Organisation (WHO) GMP is commonly used in LMICs. However, barriers to GMP compliance remain apparent, particularly in LMICs. Pharmaceutical manufacturers in LMICs face several barriers such as inadequate resources and infrastructure, inefficient or weak regulation, a shortage of skilled people and limited training opportunities for manufacturing personnel. Although national regulatory authorities (NRAs) have been established in LMICs, most NRAs are not fully independent and are placed within the health department. NRAs in LMICs are not able to fully utilise international and regional reliance mechanisms and collaborations. Therefore, both NRAs and pharmaceutical manufacturers must be adequately supported through resources, infrastructure and capacity‐building opportunities. NRAs must be suitably empowered with assured functional independence. A comprehensive guideline for managing conflicts of interest among pharmaceutical manufacturers, procurement agencies and NRAs is needed. NRAs must liaise with other NRAs, participate in joint GMP inspections and leverage the expertise of regional or international collaborations. Pharmaceutical manufacturers in LMICs can leverage WHO GMP standards to improve GMP compliance and expand their market. However, as these solutions may have cost implications, prioritising key gaps for GMP compliance and optimisation of available resources are essential.
{"title":"Good manufacturing practice in low‐ and middle‐income countries: Challenges and solutions for compliance","authors":"Pelden Chejor, T. Dorji, Ngawang Dema, Andrew Stafford","doi":"10.1002/puh2.158","DOIUrl":"https://doi.org/10.1002/puh2.158","url":null,"abstract":"Approximately 2 billion people globally have limited access to essential medicines, particularly those living in low‐ and middle‐income countries (LMICs). In addition, there is a higher prevalence of substandard and counterfeit medicines in LMICs, which may cause antimicrobial resistance and therapeutic failure. Good manufacturing practice (GMP) is key to ensuring access to high‐quality, safe and effective medicines, including active pharmaceutical ingredients and excipients used for manufacturing finished dosage forms. Compliance with GMP standards saves resources for both manufacturers (e.g. avoiding expensive product recalls) and governments (e.g. minimising compliance inspections). Concerted collaborations among different countries to harmonise GMP standards and procedures have occurred, and the World Health Organisation (WHO) GMP is commonly used in LMICs. However, barriers to GMP compliance remain apparent, particularly in LMICs. Pharmaceutical manufacturers in LMICs face several barriers such as inadequate resources and infrastructure, inefficient or weak regulation, a shortage of skilled people and limited training opportunities for manufacturing personnel. Although national regulatory authorities (NRAs) have been established in LMICs, most NRAs are not fully independent and are placed within the health department. NRAs in LMICs are not able to fully utilise international and regional reliance mechanisms and collaborations. Therefore, both NRAs and pharmaceutical manufacturers must be adequately supported through resources, infrastructure and capacity‐building opportunities. NRAs must be suitably empowered with assured functional independence. A comprehensive guideline for managing conflicts of interest among pharmaceutical manufacturers, procurement agencies and NRAs is needed. NRAs must liaise with other NRAs, participate in joint GMP inspections and leverage the expertise of regional or international collaborations. Pharmaceutical manufacturers in LMICs can leverage WHO GMP standards to improve GMP compliance and expand their market. However, as these solutions may have cost implications, prioritising key gaps for GMP compliance and optimisation of available resources are essential.","PeriodicalId":506750,"journal":{"name":"Public Health Challenges","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140484326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nsereko Etienne, Uwase Aline, Mpinganzima Ornella, Usanzineza Henriette, Niyitegeka Jean Pierre, Turabayo Jean Léonard, Mwiseneza Marie Josee, Mugeni Girimpundu Candide, Moreland Patricia
Rwanda has made progress in reducing maternal mortality, with rates decreasing by three‐quarters between 1990 and 2015, in part due to increased access to cesarean delivery (CD). However, the prevalence of CD is also increasing for reasons other than clinical indications. Rwanda's 15% CD delivery rate is higher than World Health Organization guidelines, sparking debate about optimal CD use and potential negative outcomes in child and maternal health. This study aimed to identify the key clinical and nonclinical factors relating to CD in Rwanda.A secondary data analysis of the Rwanda Demographic and Health Survey (2019–2020) was performed, using the outcome variable of vaginal birth versus CD in women who had delivered in the survey period and for 5 years preceding. We used logistic regression modeling to identify the explanatory sociodemographic, economic, and obstetric characteristics associated with CD.More than half of participants were between 20‐ and 34‐year old, 65.2% had completed primary school at least, 79.0% lived in rural areas, and 81.2% had health insurance. Fifteen percent of participants had given birth by CD in the preceding 5 years. CD was independently associated with higher levels of education, religion, higher socioeconomic status, perceived financial constraints, and giving birth in a private health facility. Obstetric predictors for CD included twin pregnancy, male infancy, and primiparity.Results suggest that indications for CD should be monitored and the birthing preferences of women further evaluated, with guidelines implemented to inform decision‐making around CD.
{"title":"Determinants of cesarean mode of childbirth among Rwandan women of childbearing age: Evidence from the 2019–2020 Rwanda Demographic and Health Survey (RDHS)","authors":"Nsereko Etienne, Uwase Aline, Mpinganzima Ornella, Usanzineza Henriette, Niyitegeka Jean Pierre, Turabayo Jean Léonard, Mwiseneza Marie Josee, Mugeni Girimpundu Candide, Moreland Patricia","doi":"10.1002/puh2.150","DOIUrl":"https://doi.org/10.1002/puh2.150","url":null,"abstract":"Rwanda has made progress in reducing maternal mortality, with rates decreasing by three‐quarters between 1990 and 2015, in part due to increased access to cesarean delivery (CD). However, the prevalence of CD is also increasing for reasons other than clinical indications. Rwanda's 15% CD delivery rate is higher than World Health Organization guidelines, sparking debate about optimal CD use and potential negative outcomes in child and maternal health. This study aimed to identify the key clinical and nonclinical factors relating to CD in Rwanda.A secondary data analysis of the Rwanda Demographic and Health Survey (2019–2020) was performed, using the outcome variable of vaginal birth versus CD in women who had delivered in the survey period and for 5 years preceding. We used logistic regression modeling to identify the explanatory sociodemographic, economic, and obstetric characteristics associated with CD.More than half of participants were between 20‐ and 34‐year old, 65.2% had completed primary school at least, 79.0% lived in rural areas, and 81.2% had health insurance. Fifteen percent of participants had given birth by CD in the preceding 5 years. CD was independently associated with higher levels of education, religion, higher socioeconomic status, perceived financial constraints, and giving birth in a private health facility. Obstetric predictors for CD included twin pregnancy, male infancy, and primiparity.Results suggest that indications for CD should be monitored and the birthing preferences of women further evaluated, with guidelines implemented to inform decision‐making around CD.","PeriodicalId":506750,"journal":{"name":"Public Health Challenges","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140483076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lise Paule Djamko Toko, Borris Rosnay Galani Tietcheu, Ilyassa Dieudonné Tembar, Pascal Dieudonné Chuisseu Djamen, Nicolas Njintang Yanou
Chikungunya virus (CHIKV) infection is a vector‐borne febrile illness endemic to Africa. In Cameroon, few studies have documented human exposure to CHIKV, especially in the Adamaoua region. This study aimed to assess the CHIKV seroprevalence in Ngaoundere city and analyze likely association with social, clinical, and biochemical determinants.A cross‐sectional study was conducted at the Ngaoundere Regional Hospital from July to October 2022. The sociodemographic and clinical informations of participants were recorded using a standardized questionnaire. Then, blood tests were performed to determine the CHIKV status, the transaminase, and lipid profiles.Of the 200 persons surveyed, 21.5% (43) were positive for anti‐CHIKV IgM antibodies. Age, sex, occupation, marital status, level of study, and place of residence were not significantly associated with CHIKV. However, fever (RR = 4.19; 42.86%; p = 0.0124), headaches (RR = 4.89; 50%; p = 0.0007), digestive disorders (RR = 6.52; 66.67%; p = 0.0001), and the presence of at least two clinical symptoms (RR = 2.55; 26.09%; p = 0.009) were significantly correlated with the presence of CHIKV compared with the absence of clinical symptoms (RR = 1, 10.23%). Similarly, cases of CHIKV were significantly more important in subjects with high aspartate aminotransferase (AST) than in those with normal AST (RR = 2.45; 37.50% vs. 15.28%; p = 0.0006). No significant association was found between alanine‐aminotransferase and lipid profile markers.Ngaoundere populations seem to be commonly infected with CHIKV, increasing the incidence of febrile symptoms and transaminase elevation. Clinical and metabolic monitoring is required.
{"title":"Seroprevalence and biochemical parameters among patients with Chikungunya in Adamaoua region, Cameroon: A cross‐sectional study","authors":"Lise Paule Djamko Toko, Borris Rosnay Galani Tietcheu, Ilyassa Dieudonné Tembar, Pascal Dieudonné Chuisseu Djamen, Nicolas Njintang Yanou","doi":"10.1002/puh2.157","DOIUrl":"https://doi.org/10.1002/puh2.157","url":null,"abstract":"Chikungunya virus (CHIKV) infection is a vector‐borne febrile illness endemic to Africa. In Cameroon, few studies have documented human exposure to CHIKV, especially in the Adamaoua region. This study aimed to assess the CHIKV seroprevalence in Ngaoundere city and analyze likely association with social, clinical, and biochemical determinants.A cross‐sectional study was conducted at the Ngaoundere Regional Hospital from July to October 2022. The sociodemographic and clinical informations of participants were recorded using a standardized questionnaire. Then, blood tests were performed to determine the CHIKV status, the transaminase, and lipid profiles.Of the 200 persons surveyed, 21.5% (43) were positive for anti‐CHIKV IgM antibodies. Age, sex, occupation, marital status, level of study, and place of residence were not significantly associated with CHIKV. However, fever (RR = 4.19; 42.86%; p = 0.0124), headaches (RR = 4.89; 50%; p = 0.0007), digestive disorders (RR = 6.52; 66.67%; p = 0.0001), and the presence of at least two clinical symptoms (RR = 2.55; 26.09%; p = 0.009) were significantly correlated with the presence of CHIKV compared with the absence of clinical symptoms (RR = 1, 10.23%). Similarly, cases of CHIKV were significantly more important in subjects with high aspartate aminotransferase (AST) than in those with normal AST (RR = 2.45; 37.50% vs. 15.28%; p = 0.0006). No significant association was found between alanine‐aminotransferase and lipid profile markers.Ngaoundere populations seem to be commonly infected with CHIKV, increasing the incidence of febrile symptoms and transaminase elevation. Clinical and metabolic monitoring is required.","PeriodicalId":506750,"journal":{"name":"Public Health Challenges","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140481989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast cancer is a common form of cancer for women. The goal of this research was to estimate how a breast cancer diagnosis affects a woman's decisions about smoking, alcohol use, and exercise.Using data from the Panel Study of Income Dynamics on breast cancer diagnosis and lifestyle choices, we estimated how being diagnosed influences smoking, drinking, and exercising habits for more than 8000 women over the period 1999–2011.Controlling for unobserved heterogeneity, persistence in behaviors, and correlation across behaviors, we found that the impact of a diagnosis had a different effect on smoking, drinking, and exercising behaviors. Furthermore, the impact depended upon the recency of the diagnosis. Recently diagnosed women exercised and smoked less—an average woman in our sample reduced exercise by 19% and smoking by 1%. However, women with breast cancer did not change their drinking habits relative to healthy women.A diagnosis of breast cancer impacts lifestyle choices. Women who were diagnosed with breast cancer in the last 5 years exercised and smoked less but did not change their alcohol consumption after a breast cancer diagnosis regardless of when the diagnosis was made. Our approach provides insight into what extent women who are faced with negative information about life expectancy take this into consideration when deciding to engage in risky behaviors that might further affect their survival. Whether to engage in physical activity, drink alcohol, or smoke are choices associated with how to live.
乳腺癌是女性常见的一种癌症。本研究的目标是估算乳腺癌诊断如何影响女性在吸烟、饮酒和运动方面的决策。我们利用《收入动态面板研究》（Panel Study of Income Dynamics）中有关乳腺癌诊断和生活方式选择的数据，估算了 8000 多名女性在 1999-2011 年期间被诊断出乳腺癌对吸烟、饮酒和运动习惯的影响。此外，这种影响还取决于诊断的新旧程度。新近确诊的女性运动量和吸烟量都有所减少--我们样本中的女性平均运动量减少了 19%，吸烟量减少了 1%。然而，与健康女性相比，患有乳腺癌的女性并没有改变她们的饮酒习惯。在过去 5 年中被诊断出患有乳腺癌的女性在被诊断出患有乳腺癌后，无论何时被诊断出患有乳腺癌，她们的运动量和吸烟量都有所减少，但饮酒量却没有改变。我们的研究方法让我们了解到，面对有关预期寿命的负面信息，妇女在决定从事可能会进一步影响其生存的危险行为时，会在多大程度上考虑到这一点。是否参加体育锻炼、饮酒或吸烟是与如何生存相关的选择。
{"title":"Lifestyle choices among women with breast cancer in the United States","authors":"Chloé Michel, Michelle Sovinsky, Steven Stern","doi":"10.1002/puh2.153","DOIUrl":"https://doi.org/10.1002/puh2.153","url":null,"abstract":"Breast cancer is a common form of cancer for women. The goal of this research was to estimate how a breast cancer diagnosis affects a woman's decisions about smoking, alcohol use, and exercise.Using data from the Panel Study of Income Dynamics on breast cancer diagnosis and lifestyle choices, we estimated how being diagnosed influences smoking, drinking, and exercising habits for more than 8000 women over the period 1999–2011.Controlling for unobserved heterogeneity, persistence in behaviors, and correlation across behaviors, we found that the impact of a diagnosis had a different effect on smoking, drinking, and exercising behaviors. Furthermore, the impact depended upon the recency of the diagnosis. Recently diagnosed women exercised and smoked less—an average woman in our sample reduced exercise by 19% and smoking by 1%. However, women with breast cancer did not change their drinking habits relative to healthy women.A diagnosis of breast cancer impacts lifestyle choices. Women who were diagnosed with breast cancer in the last 5 years exercised and smoked less but did not change their alcohol consumption after a breast cancer diagnosis regardless of when the diagnosis was made. Our approach provides insight into what extent women who are faced with negative information about life expectancy take this into consideration when deciding to engage in risky behaviors that might further affect their survival. Whether to engage in physical activity, drink alcohol, or smoke are choices associated with how to live.","PeriodicalId":506750,"journal":{"name":"Public Health Challenges","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139529197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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