Africa is the second populous continent, and its population has the fastest growing rate. Some African countries are still plagued by poverty, poor sanitary conditions and limited resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Underfunded healthcare systems, poor training and lack of awareness of policies and legislations on handling medical waste have led to increased improper handling of waste within hospitals, healthcare facilities and transportation and storage of medical waste. Some countries, including Ethiopia, Botswana, Nigeria and Algeria, do not have national guidelines in place to adhere to the correct disposal of such wastage. Incineration is often the favoured disposal method due to the rapid diminishment of up to 90% of waste, as well as production of heat for boilers or for energy production. This type of method – if not applying the right technologies – potentially creates hazardous risks of its own, such as harmful emissions and residuals. In this study, the sustainability aspects of medical waste management in Africa were reviewed to present resilient solutions for health and environment protection for the next generation in Africa. The findings of this research introduce policies, possible advices and solutions associated with sustainability and medical waste management that can support decision-makers in developing strategies for the sustainability by using the eco-friendly technologies for efficient medical waste treatment and disposal methods and also can serve as a link between the healthcare system, decision-makers, and stakeholders in developing health policies and programmes.

During pregnancy, a number of biomechanical and hormonal changes occur that can alter spinal curvature, balance, and gait patterns by affecting key areas of the human body. This can greatly impact quality of life (QOL) by increasing back pain and the risk of falls. These effects are likely to be the ultimate result of a number of hormonal and biomechanical changes that occur during pregnancy. Research Question and Methodology: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, this systematic review sets out to analyse all available literature relating to the biomechanics factors caused by pregnancy and assess how this might reduce QOL. Fifty papers were deemed eligible for inclusion in this review based on the PUBMED and SCOPUS databases. Results: Angles of lordosis and kyphosis of the spine are significantly increased by pregnancy, but not consistently across all studies. Back pain is significantly increased in pregnant women, although this is not significantly correlated with spinal changes. Increased movements of centre of pressure (COP) and increased stability indexes indicate postural control is reduced in pregnancy. Trunk range of motion, hip flexion, and extension are reduced, as well as decreased stride length, decreased gait velocity, and increased step width; again, not consistently. It is likely that each woman adopts unique techniques to minimise the effects, for example increasing step width to improve balance. Further research should focus on how altered limb kinematics during gait might affect QOL by influencing the human body, as well as assessing parameters in all planes to develop a wider understanding of pregnant biomechanical alterations.

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Female sex, older age, and winter months were found to be significant determinants of recurrent human brucellosis. Enhanced surveillance systems with an emphasis on these population characteristics will allow effective preventive and protective measures to be implemented and might alleviate the recurrence of brucellosis in the country.

Diabetic foot ulcers (DFUs) are a serious complication for people with diabetes. They result in increased morbidity and pressures on health system resources. Developments in machine learning (ML) offer an opportunity for improved care of individuals at risk of DFUs, to identify and synthesise evidence about the current uses and accuracy of ML in the interventional care and management of DFUs, and, to provide a reference for areas of future research. PubMed, Google Scholar, Web of Science and Scopus were searched using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines for papers involving ML and DFUs. In order to be included, studies needed to mention ML, DFUs, and report relevant outcome measures regarding ML algorithm accuracy. Bias in included studies was assessed using the quality assessment tool for diagnostic accuracy (QUADAS-2). 37 out of 3769 papers were included after applying eligibility criteria. Included papers reported accuracy measures for multiple types of ML algorithms in DFU studies. Whilst varying across the ML algorithm used, all studies reported at least 90% accuracy compared to gold standards using a minimum of one reported ML algorithm for processing or recording data. Applications where ML had positive effects on DFU data analysis and outcomes include image segmentation and classification, raw data analysis and risk assessment. ML offers an effective and accurate solution to guide analysis and procurement of data from interventions which are designed for the care of DFUs in small samples and study conditions. Current research is limited, and, for the development of more applicable ML algorithms, future research should address the following: direct comparison of ML applications with current standards of care, health economic analyses and large scale data collection. There is currently no evidence to confidently suggest that ML methods in DFU diagnosis are ready for implementation and use in healthcare settings.

Background: Knee osteoarthritis is a disease of the joint causing decreased function and pain.Currently, treatments range from medication to surgery, with the use of different insoles and footwear recommended. These methods are effective by either correcting the position of the knee or providing shock absorption. However, there is little understanding of the effective characteristics of these devices. Research question: This paper aims to investigate this question and provide future areas of research to help better define treatment guidelines. Foot orthoses are an example of nonpharmacological conservative treatments mentioned in National Institute for Health and Care Excellence (NICE) guidelines to treat knee osteoarthritis (OA). These include lateral wedge insoles (LWI), developed with the intention of load reduction of the knee. Different footwear has also been shown to affect pain, biomechanical and functional outcomes in knee OA patients.Methods: To address what features of LWIs and footwear make them effective in the treatment of knee OA, scientific databases were used to search for papers on this topic and then selected to be included based on pre-defined criteria. Data were extracted and analysed from these studies to provide a basis for possible areas for future development of these foot orthoses, and research required to improve clinical treatment guidelines. Databases used were PubMed, Scopus and Web of Science.Results and Significance: Thirty-four out of 226 papers were included after application of inclusion and exclusion criteria. Regarding LWIs, the characteristics showing the most beneficial effect on either biomechanical, functional or pain outcomes were customisation, fulllength, 5° elevation, shock absorption and arch support. For footwear, barefoot mimicking soles produced the most favourable biomechanics. Results also showed that insoles work in correcting the position of the knee, but it may or may not affect patients' pain and function.

Progress has been made towards controlling the Human Immunodeficiency Virus (HIV) epidemic in South Africa. However, the emergence of coronavirus disease 2019 (COVID-19) has disrupted access to health care. This systematic review aims to evaluate the impact of the pandemic on accessing HIV services at a primary health care (PHC) level in South Africa. HIV services that have been significantly impacted are highlighted, and recommendations for future public health emergencies are made. Three databases were searched in January 2022. The studies included were those that reported on HIV services at a PHC level in South Africa. From the searches, 203 papers were identified, of which 34 full texts were screened. Eleven studies met the inclusion criteria and were included in this review. Overall, decreases in HIV testing, positive HIV tests, and initiation of antiretroviral therapy (ART) were reported. Resilience of ART provision was reported, meaning that adherence to treatment was sustained throughout the pandemic. The findings showed that HIV services at private PHC facilities were unaffected, however, an overall decrease in HIV services at public PHC facilities was reported, excluding antenatal care which showed resilience.

Background Children with Phenylketonuria (PKU) need a special diet to avoid a variety of physical and psychological complications. The aim of this study was to compare and assess the effects of two interventions on and levels of phenylalanine and micronutrients in children with PKU. Methods Forty-six children with PKU (ages 1–12 years) and their caregivers were randomly assigned to one of two 10-week interventions: a caregiver educational intervention based on the Integrative Model of Behvioral Prediction (IMBP) and supplementary low-protein-modified foods. Outcomes consisted of Children's plasma phenylalanine and micronutrients (i.e., vitamin B12, vitamin D3, and zinc) and hemoglobin levels. To assess the sustainability of outcomes, we also compared the children’s phenylalanine level at five-time points including baseline and 10-week, 6 months, 12 months, and 24 months follow-ups. In addition, caregivers of both groups were asked to complete a questionnaire to assess how well the interventions were implemented as well as satisfaction with interventions. Results While a large percentage of children had phenylalanine levels out of range indicating non-adherence (69.6% and 81% in the educational and food items group, respectively), micronutrient deficiencies were not prevalent in the patient cohort. The levels of phenylalanine in both groups decreased significantly over time. However, conducting a repeated-measures ANOVA to evaluating the change in groups across five-time points, revealed a significant difference between groups (F = 4.68, p = 0.03). That is, the educational intervention was more effective in lowering the children's phenylalanine level. At 24-month follow-up, the percentage of children with a normal range of phenylalanine level in the educational and food items groups increased to 73.9 and 57.1 percent, respectively, from 26 and 38 percent at baseline. There were no significant changes in children's micronutrients level following the interventions, except in the hemoglobin. In this way, at 10-week follow-up, the mean hemoglobin of children in the educational group reduced significantly (P = 0.041). However, there was no significant difference between the two groups. In general, all caregivers completed the process evaluation checklist, the feedback was largely positive. Conclusions The results of this study demonstrated that both educational and providing food item interventions resulted in a significant reduction in phenylalanine levels. Empowering caregivers of patients, creating and fortifying social networks, providing favorable social supports, and providing access to special food items may be effective in controlling PKU. Clinical trial registration: Iranian Registry of Clinical Trials (IRCT20180506039548N1). Registered 6th Jun 2018, https://www.irct.ir/trial/30977.