Beat Stoll

Urbanisation and infectious diseases in a globalised world

Summary The world is becoming urban. The UN predicts that the worlds urban population will almost double from 3·3 billion in 2007 to 6·3 billion in 2050. Most of this increase will be in developing countries. Exponential urban growth is having a profound effect on global health. Because of international travel and migration, cities are becoming important hubs for the transmission of infectious diseases, as shown by recent pandemics. Physicians in urban environments in developing and developed countries need to be aware of the changes in infectious diseases associated with urbanisation. Furthermore, health should be a major consideration in town planning to ensure urbanisation works to reduce the burden of infectious diseases in the future.

Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial

Objective  To compare the effects of low‐level facility‐based interventions on patient retention rates for cardiovascular (CV) disease in an environment of task shifting and nurse‐led care in rural health districts in Central Cameroon.

Computer literacy and E-learning perception in Cameroon: the case of Yaounde Faculty of Medicine and Biomedical Sciences

BackgroundHealth science education faces numerous challenges: assimilation of knowledge, management of increasing numbers of learners or changes in educational models and methodologies. With the emergence of e-learning, the use of information and communication technologies (ICT) and Internet to improve teaching and learning in health science training institutions has become a crucial issue for low and middle income countries, including sub-Saharan Africa. In this perspective, the Faculty of Medicine and Biomedical Sciences (FMBS) of Yaoundé has played a pioneering role in Cameroon in making significant efforts to improve students’ and lecturers’ access to computers and to Internet on its campus.The objective is to investigate how computer literacy and the perception towards e-learning and its potential could contribute to the learning and teaching process within the FMBS academic community.MethodA cross-sectional survey was carried out among students, residents and lecturers. The data was gathered through a written questionnaire distributed at FMBS campus and analysed with routine statistical software.Results307 participants answered the questionnaire: 218 students, 57 residents and 32 lecturers. Results show that most students, residents and lecturers have access to computers and Internet, although students’ access is mainly at home for computers and at cyber cafés for Internet. Most of the participants have a fairly good mastery of ICT. However, some basic rules of good practices concerning the use of ICT in the health domain were still not well known. Google is the most frequently used engine to retrieve health literature for all participants; only 7% of students and 16% of residents have heard about Medical Subject Headings (MeSH).The potential of e-learning in the improvement of teaching and learning still remains insufficiently exploited. About two thirds of the students are not familiar with the concept of e-leaning. 84% of students and 58% of residents had never had access to e-learning resources. However, most of the participants perceive the potential of e-learning for learning and teaching, and are in favour of its development at the FMBS.ConclusionThe strong interest revealed by the study participants to adopt and follow-up the development of e-learning, opens new perspectives to a faculty like the FMBS, located in a country with limited resources. However, the success of its development will depend on different factors: the definition of an e-learning strategy, the implementation of concrete measures and the adoption of a more active and participative pedagogy.

SMS reminders to improve the tuberculosis cure rate in developing countries (TB-SMS Cameroon): a protocol of a randomised control study

BackgroundTuberculosis is a public health problem in Cameroon, just like in many other countries in the world. The National Tuberculosis Control Programme (PNLT) put in place by the state, aims to fight tuberculosis through the implementation of international directives (Directly Observed Treatment Short, DOTS). Despite the deployment of this strategy across the world, its implementation is difficult in the context of low-resource countries. Some expected results are not achieved. In Cameroon, the cure rate for patients with sputum positive pulmonary tuberculosis (TPM+) after 6 months is only about 65%, 20% below the target. This is mainly due to poor patient adherence to treatment. By relying on the potential of mobile Health, the objective of this study is to evaluate the effect of SMS reminders on the cure rate of TPM + patients, measured using 6-month bacilloscopy.Methods/designThis is a blinded, randomised controlled multicentre study carried out in Cameroon. The research hypothesis is that sending daily SMS messages to remind patients to take their prescribed tuberculosis medication, together with the standard DOTS strategy, will increase the cure rate from 65% (control group: DOTS, no SMS intervention) to 85% (intervention group: DOTS, with SMS intervention) in a group of new TPM + patients. In accordance with each treatment centre, the participants will be randomly allocated into the two groups using a computer program: the intervention group and the control group. A member of the research team will send daily SMS messages. Study data will be collected by health professionals involved in the care of patients. Data analysis will be done by the intention-to-treat method.DiscussionThe achieving of expected outcomes by the PNLT through implementation of DOTS requires several challenges. Although it has been demonstrated that the DOTS strategy is effective in the fight against tuberculosis, its application remains difficult in developing countries. This study explores the potential of mHealth to support DOTS strategy. It will gather new evidence on the effectiveness of mHealth-based interventions and SMS reminders in the improvement of treatment adherence and the cure rate of tuberculosis patients, especially in a low-resource country such as Cameroon.Trial registrationThe trial is registered on the Pan-African Clinical Trials Registry (http://www.pactr.org) under unique identification number: PACTR201307000583416.

Early assessment of the implementation of a national programme for the prevention of mother‐to‐child transmission of HIV in Cameroon and the effects of staff training: a survey in 70 rural health care facilities

Objectives  To assess the availability of equipment and the staff’s knowledge to prevent Mother‐To‐Child Transmission (PMTCT) in rural healthcare facilities recently covered by the national PMTCT programme in Cameroon.

Chickenpox in a Swiss prison: Susceptibility, post-exposure vaccination and control measures

Abstract After the occurrence of a case of chickenpox in Switzerlands largest pre-trial prison, protective measures including post-exposure vaccination were implemented, as chickenpox can cause severe complications in adults. Serology for chickenpox was carried out for all contacts of the index case and rapid post-exposure vaccination proposed to all prisoners with a negative history for chickenpox. Susceptibility was found in 14 out of 110 prisoners (12.7%; 95% confidence interval 6.5–18.9). The positive predictive value of a history of chickenpox was 90%. In this predominantly migrant population, susceptibility to chickenpox was approximately 6 times higher than in the general Swiss adult population. Since the attack rate among susceptible household contacts is usually high, preventive measures such as vaccination and quarantine probably allowed containment of the spread of infection.

Vaccines safety; effect of supervision or SMS on reporting rates of adverse events following immunization (AEFI) with meningitis vaccine (MenAfriVac™): a randomized controlled trial.

BACKGROUND To ensure vaccines safety, given the weaknesses of the national pharmacovigilance system in Cameroon, there is a need to identify effective interventions that can contribute to improving AEFI reporting. OBJECTIVE To assess the effect of: (i) sending weekly SMS, or (ii) weekly supervisory visits on AEFI reporting rate during a meningitis immunization campaign conducted in Cameroon in 2012 using the meningitis A conjugate vaccine (MenAfriVac™). METHODS Health facilities that met the inclusion criteria were randomly assigned to receive: (i) a weekly standardized SMS, (ii) a weekly standardized supervisory visits or (iii) no intervention. The primary outcome was the reported AEFI incidence rate from week 5 to 8 after the immunization campaign. Poisson regression model was used to estimate the effect of interventions after adjusting for health region, type of health facility, type and position of health workers as well as the cumulative number of AEFI reported from weeks 1 to 4. RESULTS A total of 348 (77.2%) of 451 health facility were included, and 116 assigned to each of three groups. The incidence rate of reported AEFI per 100 health facility per week was 20.0 (15.9-24.1) in the SMS group, 40.2 (34.4-46.0) in supervision group and 13.6 (10.1-16.9) in the control group. Supervision led to a significant increase of AEFI reporting rate compared to SMS [adjusted RR=2.1 (1.6-2.7); p<0.001] and control [RR=2.8(2.1-3.7); p<0.001)] groups. The effect of SMS led to some increase in AEFI reporting rate compared to the control group, but the difference was not statistically significant [RR=1.4(0.8-1.6); p=0.07)]. CONCLUSION Supervision was more effective than SMS or routine surveillance in improving AEFI reporting rate. It should be part of any AEFI surveillance system. SMS could be useful in improving AEFI reporting rates but strategies need to be found to improve its effectiveness, and thus maximize its benefits.

Alumni evaluation of a community-oriented master of public health program.

Health workforce development is a public health priority for the World Health Organization. Public Health training programs need to be relevant in a public health perspective and efficient in and educational perspective. This implies evaluating the programs: in this regard student’s perception might be interesting, or the opinion of external experts, or the experience of alumni. To study the perception of alumni of a master’s program in public health in order to reevaluate the goals and objectives of the program, a cross-sectional survey through a self-administered questionnaire among former students that graduated from the Geneva University Master in Public Health program was done. This self-administered questionnaire included closed questions on a Likert five-point scale for regarding the use at work of tools acquired during the course, as well as open questions. Overall the alumni gave a positive evaluation of the course. As strong points were mentioned: networking opportunities, student-centered approach and multi-professional background of the student body. More critically judged were: tutorship, time constraints and costs. As most useful tools in their professional settings alumni mentioned: communication skills, project evaluation competencies and literature search strategies and again networking which in this case seemed to be quite active. Evaluation surveys among alumni allow reevaluation of the program’s goals and objectives in the light of their professional needs.

Women and healthcare providers’ perceptions of a midwife-led unit in a Swiss university hospital: a qualitative study

BackgroundThe development of medical-led care in obstetrics over the past decades has contributed to improving outcomes for both mother and child. Although efficiency has improved in complex situations, unnecessary interventions are still practiced in low-risk pregnancies, contrary to international recommendations. A shift to a less interventionist model of care has encouraged many countries to review their policies on maternal health care and develop models such as the “midwife-led unit” (MLU) where the midwife plays a predominant role with a minimum of routine intervention. Existing research has provided convincing evidence that MLUs lead to better maternal and neonatal outcomes when compared to traditional models. They not only improve the level of satisfaction amongst women, but are also associated with reduced healthcare costs. This study aimed to explore the perceptions of women and healthcare providers regarding the creation of an MLU in a Swiss university hospital.MethodsA descriptive research study using qualitative methods was conducted among pregnant women and new mothers in a Swiss maternity unit, including also midwives and medical staff. Data collection was carried out through one-to-one interviews, focus groups, and telephone interviews (n = 63). After transcription, thematic analysis was performed.ResultsThe triangulation of perceptions of women and healthcare providers indicated support for the implementation of an MLU to promote physiological delivery. Most women welcomed the idea of an MLU, in particular how it could help in offering continuity of care. Healthcare providers were optimistic about the implementation of an MLU and recognised the need for some women to have access to a less interventionist approach. From the women’s perspective, barriers concerned the lack of awareness of midwives’ full scope of practice, while barriers for midwives and obstetricians were related to the challenge to develop a good interprofessional collaboration.ConclusionAlternative models to provide maternity care for low-risk women have been developed and evaluated widely in several countries outside Switzerland. This study showed that women and healthcare providers were favourable towards the development of a new care model, while taking into account the specific expectations and barriers raised by participants.

Most children who took part in a comprehensive malnutrition programme in Madagascar reached and maintained the recovery threshold

The benefits of including nutritional education in programmes that tackle moderate and severe acute malnutrition remain poorly documented. This study in Madagascar evaluated the nutritional status of children who took part in an innovative programme that included maternal education, on completion and after a year.