Background: Interest in global health training during residency is increasing. Global health knowledge is also becoming essential for health-care delivery today. Many U.S. residency programs have been incorporating global health training opportunities for their residents. We performed a systematic literature review to evaluate global health training opportunities and challenges among U.S. residency specialties. Methods: We searched PubMed from its earliest dates until October 2015. Articles included were survey results of U.S. program directors on global health training opportunities, and web-based searches of U.S. residency program websites on global health training opportunities. Data extracted included percentage of residency programs offering global health training within a specialty and challenges encountered. Results: Studies were found for twelve U.S. residency specialties. Of the survey based studies, the specialties with the highest percentage of their residency programs offering global health training were preventive medicine (83%), emergency medicine (74%), and surgery (71%); and the lowest were orthopaedic surgery (26%), obstetrics and gynecology (28%), and plastic surgery (41%). Of the web-based studies, the specialties with the highest percentage of their residency programs offering global health training were emergency medicine (41%), pediatrics (33%), and family medicine (22%); and the lowest were psychiatry (9%), obstetrics and gynecology (17%), and surgery (18%). The most common challenges were lack of funding, lack of international partnerships, lack of supervision, and scheduling. Conclusion: Among U.S. residency specialties, there are wide disparities for global health training. In general, there are few opportunities in psychiatry and surgical residency specialties, and greater opportunities among medical residency specialties. Further emphasis should be made to scale-up opportunities for psychiatry and surgical residency specialties.

BackgroundSub-Saharan Africa has the highest rates of child mortality worldwide. Little is known about post-hospital outcomes after an index hospitalization for older children. We determined 12-month post-hospital mortality rate and identified factors associated with higher mortality.MethodsIn this prospective cohort study, we enrolled children 2–12 years of age admitted to the pediatric wards of two public hospitals in northwestern Tanzania. Participants or proxies were contacted at 3, 6 and 12 months post-hospitalization. The primary outcome measured was mortality. Factors associated with mortality were determined using Cox regression analysis.ResultsA total of 506 participants were enrolled. In-hospital mortality rate was 7.7% (39/506). Of the 467 participants discharged, the post-hospital mortality rate was 10.1% (47/467). Sickle cell disease (Hazard Ratio (HR) 3.32, 95% CI 1.44–7.68), severe malnutrition (HR 3.19, 95% CI 1.18–8.57), neurologic diseases (HR 3.51, 95% CI 1.35–9.11), heart disease (HR 7.11, 95% CI, 2.89–17.51), cancer (HR 11.79, 95% CI 4.95–28.03), and septic shock (HR 4.64, 95% CI 1.42–15.08) had higher association with mortality compared to other diagnoses. The risk factors significantly associated with mortality included older age (HR 1.01, 95% CI 1.00–1.08), lower hemoglobin level (HR 0.83, 95% CI 0.76–0.90), lower Glasgow Coma Scale (HR 0.66, 95% CI 0.59–0.74), history of decreased urine output (HR 2.87, 95% CI 1.49–5.53), higher respiratory rate (HR 1.02, 95% CI 1.00–1.03), estimated glomerular filtration rate less than 60 ml/min/1.73m2 (binary) (HR 1.84, 95% CI 1.10–3.10), and lower oxygen saturation (HR 0.96, 95% CI 0.92–0.99).ConclusionsPost-hospital mortality is disturbingly high among children 2–12 years of age in Tanzania. Post-hospital interventions are urgently needed especially for older children with chronic illnesses.

Participants of the WCMC global health elective report positive experiences from our multidimensional global health collaboration.

Background: Africa is experiencing a rapid increase in morbidity and mortality related to diabetes mellitus (DM). Contemporary data are needed to guide efforts to improve prevention and treatment for microvascular complications in children and adolescents in Africa. This study was conducted to assess prevalence of diabetic microvascular complications in northwestern Tanzania, including nephropathy, retinopathy, and neuropathy, as well as associated risk factors. Objectives: 1) To determine the prevalence of microvascular complications and the overlap of nephropathy, retinopathy and neuropathy and 2) to determine factors associated with the development of microvascular complications. Methods: This cross-sectional study included 155 children and adolescents with DM consecutively attending all three health centers providing diabetes care for children in the Mwanza region of Tanzania. Participants were examined for microvascular complications and possible risk factors. Results: Fifty-one of 155 participants (age: 5-19 years) had diabetic nephropathy (32.9%), 16 had diabetic retinopathy (10.3%), and 21 had diabetic neuropathy (13.6%). Risk factors for development of a microvascular complication included age, duration of DM, and poor glycemic control. Of the participants, 107 had poor levels of glycemic control (69%) with HbA1C levels >10%. Conclusion: The prevalence of microvascular complications, especially that of nephropathy, was disturbingly high. Risk factors for microvascular complications were similar to other studies from Africa and included poor glycemic control, older age, and longer duration of DM. Innovative, locally appropriate systems for optimizing glycemic control are urgently needed.

Background Africa has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia. Objective To determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia. Methods We conducted a prospective cohort study enrolling children 2–12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis. Results Of the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53–3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00–1.03) and decreased urine output (HR 4.30, 95% Cl 1.04–17.7). Conclusions Children up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children.

Kartagener's syndrome and radiofrequency catheter ablation for the treatment of atrial flutter have been well described in separate reports. This case report includes both in describing a patient with Kartagener's syndrome who had medically refractory atrial flutter that was successfully treated with radiofrequency catheter ablation.

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DH) 30 31 ¶ These authors contributed equally to this work. 32 33 34 35 2 1 Abstract 2 Background: Africa has the highest rates of child mortality. Little is known about outcomes 3 after hospitalization for children with very severe anemia. 4 5 Objective: To determine one year mortality and predictors of mortality in Tanzanian children 6 hospitalized with very severe anemia. 7 8 Methods:We conducted a prospective cohort study enrolling children 2-12 years hospitalized 9 from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children 10 were screened for anemia and followed until 12 months after discharge. The primary outcome 11 measured was mortality. Predictors of mortality were determined using Cox regression analysis. 1213 Results: Of the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not.14 Mortality was higher for children with very severe anemia compared to children without over a 15 one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio 16 (HR) 2.42, 95% Cl 1.53-3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital 17 mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of 18 mortality were age (HR 1.01, 95% Cl 1.00-1.03) and decreased urine output (HR 4.30, 95% Cl 19 1.04 -17.7). 20 21 Conclusions: Children up to 12 years of age with very severe anemia have nearly a 30% chance 22 of mortality following admission over a one year period, with over 50% of mortality occurring 3 23 after discharge. Post-hospital interventions are urgently needed to reduce mortality in children 24 with very severe anemia, and should include older children. Very severe anemia (hemoglobin concentration less than 5.0 g/dL) is a major cause of morbidity 48 and mortality among children in Africa. Of hospitalized children, 12 to 29% have very severe 49 anemia, and the in-hospital mortality of these children range between 4 to 17% [1-9]. Little is 50 known about the long-term outcomes for children with very severe anemia after hospitalization 51 [10]. The few data that have been published have been limited to children under five years of age 52 [9]. Studies are lacking regarding long-term outcomes after hospitalization that include older 53 children with very severe anemia. 5455 Therefore, we conducted a prospective cohort study of Tanzanian children up to 12 years of age 56 hospitalized with very severe anemia and followed until one-year after hospital discharge. Our 57 study objectives were: 1) to determine the prevalence of very severe anemia for hospitalized 58 children, 2) to compare mortality in children with very severe anemia to children without very 59 severe anemia up to one year post-hospitalization, and 3) to identify predictors of mortality for 60 children with very severe anemia. 61 62 63 64 65 66 67 68 69 70 71 72 73 5 74 Methods 75 76 Study site 77 This study is a secondary analysis of a prospective cohort study where we consecutively 78 screened and enrolled children hospitalized on t...