Use of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths.

Educational or counselling interventions may improve completion of treatment for latent tuberculosis. As would be expected, the magnitude of the benefit is likely to depend on the nature of the intervention, and the reasons for low completion rates in the specific setting.

I n areas without adequate medical facilities and resources, cesarean delivery (CD) can increase maternal and newborn risks and raise medical costs. It is also a marker for the availability and use of obstetric services in resource-poor countries. This survey studied the mode of delivery and maternal and perinatal outcomes in African health facilities and the association of institutional CD rates with maternal and perinatal morbidity and mortality. Data from 7 of 46 African countries who are surveyed by the World Health Organization for maternal and perinatal health were randomly selected for inclusion. The data from each country were divided and recombined into 21 geographic units, covering the capital city of each country, and 2 randomly selected provinces in every participating country (Algeria, Angola, Democratic Republic of Cong, Niger, Nigeria, Kenya, and Uganda). From 699 health facilities in the geographic areas, 133 were randomly selected (2 facilities declined to participate). Among these 131 facilities, 83,439 deliveries were recorded during the study period. Maternal data included risk indicators, the mode of delivery, and maternal and newborn outcomes until discharge or during hospital stay up until 7 days postpartum. Institutional outcomes included adequacy of laboratory tests, amount of anesthesia resources, measures of intrapartum care including emergency obstetric care, and the amount of human resources. A health facility classification score (HFCS) was determined based on basic services, general medical services, availability of screening tests, emergency obstetric care, intrapartum care, and human resources. Each domain was scored as basic, comprehensive, or advanced, and the sum of the scores comprised the HFCS.Most births (81.7%) occurred in governmental facilities. Thirty facilities overall had low HFCS; 54 and 47 facilities had medium and high scores, respectively, and 1% charged fees for delivery. The median CD rate was 8.8% but such deliveries were performed in only 95 (72.5%) of the facilities. Among facilities doing CDs, the median rate for CD was 13.4% of deliveries (range, 2.3%-27.3%). Facilities with higher percentages of women with previous CD, preeclampsia, induced labor, referrals, and higher HFCS had higher CD rates. Midwives did 75% of the normal deliveries and specialist and trainee obstetricians, general physicians, and nonphysicians performed 60%, 33%, and 6% of CDs, respectively. Nearly 50% of operative vaginal deliveries (3% of all deliveries) were performed by midwives, nurses, or other paramedical personnel. CDs were performed for cephalopelvic disproportion, dystocia, or failure to progress in 30.9% of patients, for fetal indications in 25%, for previous CD in 21.5%, and malpresentation in 13% of patients. Socio-demographic characteristics, past reproductive history, variables in the current pregnancy and during childbirth, and facility characteristics accounted for 64%, 41%, 35%, and 44% of the variation in CD rates among the institutions, respectively. The overall mate...

Mentorship during and after FIC research training programs, while largely informal in nature, appears to have very positive impacts upon career development and inclination to remain in health research. Local African mentors often play a critical mentorship role, and their contributions should be better recognized.

BackgroundThe Fogarty International Center (FIC) has supported research capacity development for over twenty years. While the mission of FIC is supporting and facilitating global health research conducted by U.S. and international investigators, building partnerships between health research institutions in the U.S. and abroad, and training the next generation of scientists to address global health needs, research capacity may impact health policies and programs and therefore have positive impacts on public health. We conducted an exploratory analysis of how FIC research training investments affected public health policy and program development in Kenya and Uganda.MethodsWe explored the long term impacts of all FIC supported research training programs using case studies, in Kenya and Uganda. Semi-structured in-depth interviews were conducted with 53 respondents and 29 focus group discussion participants across the two countries. Qualitative methods were supplemented by structured surveys of trainees and document review, including a review of evidence cited in policy documents.ResultsIn the primary focal areas of FIC grants, notably HIV/AIDS, there were numerous examples of work conducted by former FIC trainees that influenced national and global policies. Facilitators for this influence included the strong technical skills and scientific reputations of the trainees, and professional networks spanning research and policy communities. Barriers included the fact that trainees typically had not received training in research communication, relatively few policy makers had received scientific training, and institutional constraints that undermined alignment of research with policy needs.ConclusionsWhile FIC has not focused its programs on the goal of policy and program influence, its investments have affected global and national public health policies and practice. These influences have occurred primarily through strengthening research skills of scientists and developing strong in-country networks. Further success of FIC and similar initiatives could be stimulated by investing more in the training of policy-makers, seeking to better align research with policy needs through more grants that are awarded directly to developing country institutions, and grants that better incorporate policy maker perspectives in their design and governance. Addressing structural constraints, for example supporting the development of national research agendas that inform university research, would further support such efforts.

Aim: To determine the prevalence of dental caries and its impact on QoL among HIV-infected children in Kenya. Study design: Cross-sectional survey of HIV-positive children aged 3-15 years. Method: Two hundred and twenty participants were selected by consecutive sampling. Dental examination was undertaken to determine the presence of dental caries among the children using the dmft/DMFT indices. The children's perceived QoL in the domains of oral symptoms, functional limitations, emotional and social wellbeing was assessed using the WHO Simplified Oral Health Questionnaires for children. Results: The overall prevalence of dental caries was 65% whence the prevalence in the deciduous dentition was 50% while that of the permanent dentition was 30.9%. The mean dmft and DMFT scores were 1.75 and 1.08 respectively. Children with high dmft manifested negative impacts on appearance, chewing, biting hard foods and missing school on account of toothache and discomfort, while in the permanent dentition children with high DMFT had a negative impact on biting hard foods. Conclusion: A high caries experience had significant negative impacts on the children's QoL, especially in the primary dentition.

BackgroundWhether and how research training programs contribute to research network development is underexplored. The Fogarty International Center (FIC) has supported overseas research training programs for over two decades. FIC programs could provide an entry point in the development of research networks and collaborations. We examine whether FIC’s investment in research training contributed to the development of networks and collaborations in two countries with longstanding FIC investments – Uganda and Kenya – and the factors which facilitated this process.MethodsAs part of two case studies at Uganda’s Makerere University and Kenya’s University of Nairobi, we conducted 53 semi-structured in-depth interviews and nine focus group discussions. To expand on our case study findings, we conducted a focused bibliometric analysis on two purposively selected topic areas to examine scientific productivity and used online network illustration tools to examine the resulting network structures.ResultsFIC support made important contributions to network development. Respondents from both Uganda and Kenya confirmed that FIC programs consistently provided trainees with networking skills and exposure to research collaborations, primarily within the institutions implementing FIC programs. In both countries, networks struggled with inclusiveness, particularly in HIV/AIDS research. Ugandan respondents perceived their networks to be more cohesive than Kenyan respondents did. Network cohesiveness was positively correlated with the magnitude and longevity of FIC’s programs. Support from FIC grants to local and regional research network development and networking opportunities, such as conferences, was rare. Synergies between FIC programs and research grants helped to solidify and maintain research collaborations.ConclusionsNetworks developed where FIC’s programs focused on a particular institution, there was a critical mass of trainees with similar interests, and investments for network development were available from early implementation. Networks were less likely to emerge where FIC efforts were thinly scattered across multiple institutions. The availability of complementary research grants created opportunities for researchers to collaborate in grant writing, research implementation, and publications. FIC experiences in Uganda and Kenya showcase the important role of research training programs in creating and sustaining research networks. FIC programs should consider including support to research networks more systematically in their capacity development agenda.

COVID toes or chilblain-like skin lesions represent a widespread and specific skin presentation mostly in the feet that may be attributed to COVID-19 infection.They may last for several months. We conducted this study to investigate chilblainlike lesions in children during the COVID-19 pandemic, any predisposition, location, clinical course, and prognosis. We searched Google Scholar, Scopus, and Medline (PubMed) databases using the following keywords: "Coronavirus" OR "COVID-19" AND "Chilblains" OR "Pernio" OR "Perniosis" OR "Children" OR "Cutaneous" OR "skin." The inclusion criteria were: (a) Studies that described the specific vascular skin lesion. (b) Studies that included patients aged >1 month till 18 years. (c) Case reports, case series, retrospective or prospective cohort studies, case-control studies. A total of 28 articles were included. The total number of children with chiblain-like lesions (CLL) was 433. The mean age of children presenting CLL during the COVID-19 pandemic was estimated as 12.58 ± 2.15. Of note, 53.6% of them were male. The nasopharyngeal SARS-CoV-2 RT-PCR test and anti-SARS-CoV-2 antibodies were mostly negative for the virus. In conclusion, it is crucial to be familiar with various presentations of COVID-19 infection and their clinical significance to approach the earliest diagnosis, immediate treatment, estimate the prognosis, and finally isolate the patients to prevent spreading. Chilblainlike lesions as a possible cutaneous presentation of COVID-19 in children may last several months with the indolent course.