As coronavirus disease 2019 (COVID-19) spreads across Africa, little is known about the impact of the pandemic on health-care workers (HCWs) in the region. We designed an anonymous survey distributed via e-mail and phone messaging to 13 countries through the African Hepatitis B Network. We obtained 489 analyzable responses. We used risk ratio analysis to quantify the relationship between binary variables and χ2 testing to quantify the statistical significance of these relationships. Median age of respondents was 30 years (interquartile range, 26–36 years) and 63% were physicians. The top three sources of information used by HCWs for COVID-19 management included the Ministry of Health of each country, the WHO, and social media. Forty-nine percent reported a decrease in income since the start of the pandemic, with the majority experiencing between a 1% and a 25% salary reduction. Sixty-six percent reported some access to personal protective equipment; only 14% reported appropriate access. Moreover, one third of respondents reported no availability of ventilators at their facility. Strikingly, the percentage of HCWs reporting never feeling depressed changed from 61% before the pandemic to 31% during the pandemic, with a corresponding increase in daily depressive symptoms from 2% to 20%. Most respondents (> 97%) correctly answered survey questions about COVID-19 symptoms, virus transmission, and prevention. Our survey revealed African HCWs face a variety of personal and professional context-dependent challenges. Ongoing support of HCWs through and after the COVID-19 pandemic is essential.
Hepatitis B infection (HBV) is one of the most common causes of hepatocellular carcinoma (HCC) worldwide. The age of occurrence, prognosis and incidence vary dramatically depending on the region of the world. This geographic variation is largely dependent on the contrasting incidence of HBV, age of transmission of the virus, the timing of integration into the human genome, and different HBV genotypes, as well as environmental factors. It results in a wide difference in viral interaction with the immune system, genomic modulation and the consequent development of HCC in an individual. In this review, we describe many factors implicated in HCC development, provide insight regarding at-risk populations and explain societal recommendations for HCC surveillance in persons living with HBV in different continents of the world.
Objectives:To evaluate the outcome of free conjuctival autograft in patients with grades III and IV pterygia and to determine the post-operative recurrence rate. Design: A prospective descriptive study. Setting: Menelik II Hospital, Addis Ababa, Ethiopia. Participants: Thirty four patients, 32 with primary and two with recurrent pterygia. Intervention: A superficial Keratectomy extending beyond the corneal lesion all around and sufficiently deep to Bowman's layer to produce a perfectly clear cornea in the excised area followed by suture a free conjuctival autograft on the excised area. Main outcome measures: Improvement in visual acuity and recurrence rate of pterygia at follow up. Results: Of the 32 patients followed up, the visual acuity remained the same on eight and improved in 24 cases. There were no intraoperative complications. Pterygia recurred in two patients between three and four months postoperatively. Conclusion: This study suggests that a free conjuctival autograft in the management of stage III and IV pterygia is a useful operation resulting in a very low recurrence rate of the pathology.
Purpose: To evaluate the characteristics and response to therapy for HCC in sub-Saharan Africa. Patients and methods:We retrospectively evaluated demographic, clinical and outcome variables of individuals diagnosed with HCC in a referral clinic in Ethiopia from 2016 to 2018. Survival assessment was performed using the Mann-Whitney test. Associations between categorical variables was assessed using Pearson Chi-square test. A P-value ≤ 0.05 determined statistical significance.Results: Forty-six HCC cases were reported, with a median age of 54 years (IQR 45 -62) and half of them being female. Viral hepatitis was the most common underlying etiology of liver disease, with 41% of subjects infected with hepatitis B virus (HBV) and 45% with hepatitis C. The median MELD was 12 (IQR 8-17) and we found no association between survival and a MELD score > 15, regardless of underlying disease (pr=0.61, p>0.05). Thirty-one percent of individuals underwent supportive treatment with a median survival of 27 days (IQR 19-181), 18% used Sorafenib (median survival of 94 days, IQR 24-121), and trans-arterial chemoembolization (TACE) with curative intent was utilized in 16% (median survival of 352 days, IQR 30-436). In those treated with sorafenib, a neutrophil-to-lymphocyte ratio (NLR) of <2.5 correlated with better survival (109 vs 68 days for NLR >2.5, p=0.01). HBV cases were diagnosed younger (31% before
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