Reducing Liver Cancer Risk in African-Born Immigrants Through Culturally Targeted Hepatitis B Group Education Programs

Of 900 West African-born immigrants living in New York City who were tested for hepatitis B virus (HBV), over 9% were found to have the infection (Shankar H et al. Clin Infectious Dis 62(S4):S289–s297, 2016). Community targeted group education programs (EP) have been shown to improve immigrant population’s health (Bailey E et al. J Natl Med Assoc 92(3):136–42, 2000). Our aim is to enhance HBV screening in at-risk West African immigrants through the development of a group EP as a first critical step to reducing liver cancer risk. The framework for an HBV group EP was created based on our prior work to identify barriers and facilitators for HBV screening in this community (Sriphanlop, P et al. Am J Health Behav 5(10):745–754, 2014). The framework was then refined with input from community “gatekeepers” or leaders (n = 57) through four focus groups. After refining the group EP, we then pilot tested the EP with 154 participants from eight different West African communities with a pre-/post-test HBV knowledge survey assessment to determine the impact of the group EP. Results from the pre-/post-test survey assessment demonstrated a significant increase in HBV knowledge after the EP (70% pre-test vs. 88% post-test, p value <.01). Through a community-based participatory approach, a group EP could be effective in increasing knowledge about HBV infection and HBV screening as a first step to reducing liver cancer risk.     

The concept of tropical neuromyelopathy

Since the beginning of this century, the concept of tropical neuromyelopathy (T. N. M.) was progressively elaborated in tropical areas. This disorder is constituted by three main clinical syndromes (e.g.: polyneuropathy, spastic paraplegia, ataxia). Abnormal clinical, electrophysiological and pathological features, observed in all clinical forms argue in favor of a diffuse pathobiological process of the nervous system. The association with positive HTLV-1 serology, has recently induced a great interest for the spastic forms of T. N. M. Tropical spastic paraplegia tend to be individualized. This attitude differs from the global concept of T. N. M. which allows gathering similar clinical syndromes. This T. N. M. group should be kept intact until the discovery of new etiologies. Toxic (manioc, lathyrism) or deficiency (hypovitaminosis, malabsorption) causes are incriminated. Otherwise etiologies are unknown.     

Hematologic abnormalities and immunodepression in HIV/AIDS- related pulmonary tuberculosis]

Our objectives were to describe hemato-immunological abnormalities encountered in tuberculosis patients HIV seropositive (TBVIH+, n = 67) or not (TBVIH-, n = 39) and in HIV asymptomatic patients (aSVIH+, n = 40). We found: a great reduction of mean value of RBC and Hb in TBVIH+ and TBVIH-; a reduction of mean value of leucocytes, total lymphocytes and CD4+ lymphocytes in TBVIH+ and aSVIH+; an inversion of [formula: see text] ratio, more important in TBVIH+ than in aSVIH+. HIV and tuberculosis association, HIV1 serotype and CD4 < 200/mm3 were found to promote significantly hemato-immunological abnormalities.     

Treatment of status epilepticus in a developing country]

Status epilepticus (SE) is a condition requiring emergency care, which is often poorly managed in developing countries due to the lack of personnel, drugs, and insufficient technical and medical means. This study aims at determining the epidemiologic and etiologic characteristics and the difficulty in treating SE under the existing medical practice conditions in a developing country such as Senegal. A retrospective study was therefore carried out based on SE medical files at the University Hospital of Dakar over the period January 1988 to December 1998, and included several hospital departments, i.e., paediatrics, infectious diseases and neurology. Over an 11-year period 697 cases were recorded; of these, 48.2% of patients were under 5 years of age. The seizures were generalized in 58.2% of cases, partial in 21.2%, partial secondarily generalized, or with an association of both clinical presentations in 20.6% of cases. The etiology was as follows: mainly infectious (67%), followed by resistant and/or unbalanced epilepsy (9.9%), epilepsy of vascular origin (8%), and various other causes. The overall mortality rate was 24.8%. A long period between the onset of clinical symptoms and hospital treatment was noted, with an average time lapse of 16.6 h before treatment. The drugs utilized were diazepam and phenobarbitol, administered by injection. The overall outcome could be improved by better management, i.e., better prevention and an efficient treatment of infectious diseases, a reduction in the time before treatment, and improved means of intensive care.     

Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study

BackgroundTo prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course.ObjectiveThe aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses.MethodsThe primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform’s statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access.ResultsDuring the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course.ConclusionsThe online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout.     

Environmental lead exposure and its relationship to traffic density among Senegalese children: a pilot study

In Senegal, as in many developing countries, traffic density is increasing in urban areas; in Dakar more than 50% of vehicles use gasoline. Yet the extent and real magnitude of the problem has neither been recognized nor assessed in these countries. Systemic data assessment of lead pollution and people's exposure are not well known in Senegal. This study was also designed to determine the impregnation levels of the lead released by the exhaust of cars and the changes of some early biological markers in Senegalese children. Blood lead (BPb) levels showed that all the children enrolled were exposed. However, lead exposure levels (from 34.7 to 145.8 microg/L) were less important for children living in rural areas (60.9+/-18.3 microg/L) than for those living in urban areas (106.7+/-16.9 microg/L). These changes could be correlated to the difference in the automobile traffic between both these regions (P < 0.001). BPb mean levels found in boys were higher than those in girls (P < 0.05). Despite elevated BPb levels, all values for blood zinc protoporphyrin and urine delta-aminolevulinic acid were within physiological ranges. In addition, variations in some biological markers of oxidative stress and renal disorders were seen; however, they must be confirmed by a future epidemiological study.     

Health seeking behaviour and household health expenditures in Benin and Guinea: the equity implications of the Bamako Initiative

Curative and preventive care utilization in Bamako Initiative health centres in Guinea and Benin increased significantly. Service based data and household survey results are compared and interpreted to evaluate the equity aspects of the Bamako Initiative programmes in these settings. Improvements in the use of preventive services are shared by the richer and poorer groups of the population. Inequities are more apparent regarding curative area. An important part of the population is not using Bamako Initiative Health Centres for financial reasons. However, the poor were found to use these Health Centres relatively more than richer socio-economic groups. Challenges of the future are identified and recommendations made as to how to tackle the problem of true indigence.