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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCARs). There is scant literature on the characteristics and causes of these conditions among the Nigerian population. Here, we describe the epidemiology, associated morbidity and mortality, and culpable drugs in SJS and TEN cases using the National Pharmacovigilance (NPC) database in Nigeria. Antiretroviral and antibiotics were the commonly reported offending group of drugs for SJS and TEN cases. Nevirapine and co-trimoxazole were the commonly reported suspect drugs. SJS and TEN were reported most frequently in females and in patients aged 19–40  years, indicating that drug surveillance and counseling in these groups of patients may be beneficial.

We describe a novel training programme, the tuberculosis Data Fellowship, designed to build capacity in low- and middle-income countries for tuberculosis data analytics. The programme was piloted in six countries (Bangladesh, Ethiopia, Ghana, Malawi, Mozambique) in July 2018 and Nigeria in September 2018; 20 participants completed the training. A number of key outputs have been achieved, such as improved instrument utilisation rates, decreased error rates, and improved instrument management. The training programme empowers local tuberculosis programme staff to discover and fix critical inefficiencies, provides high-level technical and operational support to the tuberculosis programme, and provides a platform for continued sharing of insights and best practices between countries. It supports the notion that connectivity can increase efficiencies and clinical benefits with better data for decision making, if coupled with commensurate capacity building in data analysis and interpretation.

To identify and to assess factors enhancing or hindering the delivery of breast and cervical cancer screening services in Malawi with regard to accessibility, uptake, acceptability and effectiveness, a search of six bibliographic databases and grey literature was executed to identify relevant studies conducted in Malawi in English. One hundred and one unique records were retrieved and 6 studies were selected for final inclusion in the review. Multiple factors affect breast and cervical cancer service delivery in Malawi, operating at three interlinked levels. At the patient level, lack of knowledge and awareness of the disease, location, poor screening environment and perceived quality of care may act as deterrents to participation in screening; at the health facility level, services are affected by the availability of resources and delivery modalities; and at the healthcare system level, inadequate funding and staffing and lack of appropriate monitoring and guidelines may have a negative impact on services. Convenience of screening, in terms of accessibility and integration with other health services, was found to have a positive effect on service uptake. Building awareness of cancer and related services and offering quality screening are significant determinants of patient satisfaction. Capitalising on these lessons is essential to strengthen breast and cervical cancer service delivery in Malawi, to increase early detection and to improve survival of women.

The aim of this paper is to explore the prevalence and factors associated with awareness of cervical cancer among women of reproductive age in Republic of Benin and Zimbabwe, sub-Saharan Africa. About 15,928 and 9,955 women aged 15–49  years were included in this study, respectively. While the majority (79.2%) of women from Zimbabwe have heard about cervical cancer, only about one-tenth (10.2%) of their Beninese counterparts have heard about the disease. The study has revealed that socio-demographical factors including geographical location and selected economic factors explained the inequality in distribution of women’s awareness on cervical cancer in both countries. Designing an effective population-based health education and promotion intervention programs on cervical cancer will be a great way forward to improving women’s awareness level on cervical cancer.

Tuberculosis (TB) is geographically heterogeneous, and geographic targeting can improve the impact of TB interventions. However, standard TB notification data may not sufficiently capture this heterogeneity. Better understanding of patient reporting patterns (discrepancies between residence and place of presentation) may improve our ability to use notifications to appropriately target interventions. Using demographic data and TB reports from Dhaka North City Corporation and Dhaka South City Corporation, we identified wards of high TB incidence and developed a TB transmission model. We calibrated the model to patient-level data from selected wards under four different reporting pattern assumptions and estimated the relative impact of targeted versus untargeted active case finding. Movement of individuals seeking TB diagnoses may substantially affect ward-level TB transmission. Better understanding of patient reporting patterns can improve estimates of the impact of targeted interventions in reducing TB incidence. Incorporating high-quality patient-level data is critical to optimizing TB interventions.

Seasonal malaria chemoprevention (SMC) aims to prevent malaria in children during the high malaria transmission season. The Achieving Catalytic Expansion of SMC in the Sahel (ACCESS-SMC) project sought to remove barriers to the scale-up of SMC in seven countries in 2015 and 2016. We evaluated the project, including coverage, effectiveness of the intervention, safety, feasibility, drug resistance, and cost-effectiveness. SMC at scale was effective in preventing morbidity and mortality from malaria. Serious adverse reactions were rarely reported. Coverage varied, with some areas consistently achieving high levels via door-to-door campaigns. Markers of resistance to sulfadoxine–pyrimethamine and amodiaquine remained uncommon, but with some selection for resistance to sulfadoxine–pyrimethamine, and the situation needs to be carefully monitored. These findings should support efforts to ensure high levels of SMC coverage in west and central Africa.

The objective of this study was to investigate the role stressors, sociodemographic characteristics and job tasks of health surveillance assistants (HSAs) and to explore major predictors of role stressors and job satisfaction of HSAs in Malawi. Data were collected from health centres and hospitals of three Malawi districts of Mangochi, Lilongwe and Mzimba. Respondents were 430 HSAs. The key findings of this study were role ambiguity and role overload were significantly negatively related to job satisfaction, while role conflict was insignificantly related to job satisfaction. Additionally, the clinical tasks of the HSAs and some of the sociodemographic variables were associated with the role stressors and job satisfaction of the HSAs in Malawi. Since the HSAs' clinical tasks were significantly related to all role stressors, there is need by the government of Malawi to design strategies to control the role stressors to ensure increased job performance and job satisfaction among HSAs. Furthermore, studies may be required in the future to assist government to control role stressors among HSAs in Malawi.

AbstractTo maintain momentum towards improved malaria control and elimination, a vaccine would be a key addition to the intervention toolkit.

We reviewed research repositories and compiled directories of research in Ethiopia from Jan 1, 2001 to Dec 30, 2017 to find evidence-based information for stakeholders and beneficiaries intervening in TB in Ethiopia. We presented literatures by four themes (biomedical and clinical; epidemiological; operational or implementation; and health systems). A total of 1,571 research studies and reports were accessed and revealed 635 epidemiological studies, followed by 538 clinical or biomedical studies, 257 operational or implementation research, and 141 health systems research. Interestingly, up to 2008 clinical or biomedical researchers were the leading researchers and from 2009 onwards, epidemiological researches held the largest constituency. TB or TB/HIV and MDR-TB literatures in Ethiopia have substantially increased over years. We suggest the need to focus on operational or implementation and health system research to decrease the spread and impact of the disease.

To delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes, we conducted a cross-sectional analytical study. We analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO’s AWaRe categorisation of antibiotics. Approximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin–cloxacillin). Empirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.

Human resources for health challenges related to training, deploying, and sustaining an effective health workforce have remained a barrier to successful program implementation at different levels of the health system.

In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and Leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites. Over the period 2013–2015, the RR-TB/MDR-TB treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates.

Please download to read the USAID Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) Activity in Ukraine News Digest, January 2021 edition.

CORE Plus training course conducted for Syrian NGOs in Turkey, 2017. Photo Credit: Steven Collins/MSHPURPOSETo achieve universal health coverage it is essential to know the cost of services so that sufficient resources can be provided for good quality of care.

Tuberculosis (TB) patients face many psychological, social and economic problems that complicate treatment and care.

The Multidrug Resistant Tuberculosis (MDR-TB) Cost Effectiveness Analysis Tool is a simple, user-friendly, generic tool that is allows countries to compare the cost-effectiveness of different MDR-TB diagnoses and treatment methods. The tool builds on previous studies about MDR-TB control cost-effectiveness and WHO guidelines on TB control costs and cost-effectiveness.

Multi-Drug Resistant TB is a major problem in many countries. Cases can be difficult to find and hard and expensive to treat. This tool provides a simple way for managers to compare the cost-effectiveness of different diagnostic and treatment strategies (e.g.

Multi-Drug Resistant (MDR) TB patients incur significant costs for seeking and undergoing treatment.

HOSPICAL: A Tool for Allocating Hospital Costs can help improve a hospital’s performance and enhance its financial sustainability. Managers who use this practical tool will find it a tremendous aid in analyzing current costs and revenues, comparing efficiency, and forecasting what those figures would be if hospital services are expanded or modified.

TB is a major problem in many countries and consumes significant external and domestic resources.The TB Service Delivery Costing Tool was developed to help TB Program Managers have a better understanding of the current and future cost of TB programs to help identify where greater efficiency and cost-effectiveness can be achieved and to help advocate for the provision of adequate funding.  It

PurposeThe purpose of the framework is to provide a structure for developing an integrated plan and budget.DescriptionThe Planning, Costing and Budgeting (PCB) Framework is an Excel spreadsheet workbook designed to allow users to clearly identify the linkages between all elements of a plan – the activities, strategies, objectives and goals, and the budget that would be required to achieve th

PurposeThe purpose of the Community Health Services Costing Tool is to help managers and planners estimate the costs of providing health services at the community level. It can be used for individual community services, packages of services, or for all community services.

PurposeThe results and analysis will provide evidence-based data for implementing, scaling-up, and maintaining iCCM activities that will be invaluable for successful funding advocacy, for conducting feasibility/sustainability studies, for assessment of cost-effectiveness, and for planning financing strategies and mechanisms.DescriptionDiarrhea, malaria and pneumonia are leading causes of child mor

PurposeThe Performance-Based Financing Dashboard is an effective and user-friendly Excel-based tool that program managers can use to improve oversight and performance of grants and contracts.

MSH authors have published a number of journal articles describing the accredited drug seller implementation experience and lessons learned in Tanzania—home of the flagship ADDO program. A new compendium reviews highlights ranging from robust multi-method quantitative to informative qualitative research. 

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