The Promotion and Development of One Health at Swiss TPH and Its Greater Potential

"It is difficult for us to treat their pain". Health professionals' perceptions of Somali pastoralists in the context of pain management: a conceptual model

Pain is one of the most neglected areas of care in sub-Saharan Africa. Access to adequate pain management is important, especially in marginalised populations, such as pastoralists. Little is known about health professionals' perceptions of pain-related care for Somali pastoralists. This study seeks to understand health professionals' perceptions of Somali pastoralists in the context of pain management in Eastern Ethiopia. Within the scope of this qualitative multicentre study, we conducted semi-structured interviews with 17 health professionals (mainly nurses) experienced in treating Somali pastoralists with pain. Data analysis was based on the coding paradigm proposed by Strauss and Corbin within Grounded Theory methodology and resulted in a conceptual model of pastoralist-specific pain management. We gave voice to pastoralists in the study design, for example, through focus group discussions conducted prior to this study. Our study is part of a larger ongoing research project involving health professionals and pastoralist communities. The perspective of pastoralists is explored in a consecutive study. 'Patient-professional relationship' was the core category we identified within the conceptual model. This category was closely linked with issues of '(mis)trust' and 'communication (barriers)'. 'Patient-related conditions' (eg, (under)-reporting of pain, care preferences and beliefs) and 'health professional-related' conditions' (eg, insufficient training, (under)exposure to local culture) had an influence on the core category. Contextual factors proved to be relevant as well, such as age and gender. The study highlights the complexity of pain management among marginalised communities, such as pastoralists. Health professionals perceive Somali pastoralists to have distinct illness beliefs and pain concepts influencing their health-seeking behaviour. The study highlights the importance of reaching this patient group with culturally acceptable and comprehensive pain management strategies.

"I could not bear it": Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative study

BACKGROUND

Pain is a major public health problem in the Global South, particularly among marginalized communities, such as Somali pastoralists. Yet, the topic of chronic pain has not yet been comprehensively studied in Sub-Saharan Africa, specifically in the Somali region of Ethiopia. Therefore, this study aims to explore the perceptions and notions of chronic pain among Somali pastoralists in this context.

METHODS

This study used an explorative qualitative design. We performed semi-structured, face-to-face interviews with 20 purposively selected female and male Somali pastoralists with chronic pain. For data analysis, we applied the Framework Method by Gale et al. and explained patterns drawing on the Enactive Approach to Pain proposed by Stilwell and Harman.

FINDINGS

Six different themes emerged: (1) "Pain as a symptom of harsh daily life", (2) "Pain descriptions and dimensions", (3) "Temporality of pain", (4) "Pain-related stigma and stoicism" (5) "Mediating role of spirituality", and (6) "Impact of pain on daily life activities".

CONCLUSIONS

Somali pastoralists described their chronic pain as a multicausal and relational experience. Pastoralists (especially women) commonly refrained from communicating their pain and represented aspects of social stigma and stoicism. The mediating role of spirituality aided pastoralists to make sense of their pain and to ease its impact on their harsh daily life. The findings of this study can contribute to raise awareness of chronic pain issues among pastoralists. They highlight the need for policymakers to prioritize the improvement of pastoralist-specific pain management. Necessary resources and skills should be available within health care facilities. Pain management should be accessible, affordable and culturally acceptable for this population.

Rift Valley fever and malaria co-infection: A case report

Key Clinical Message

We report a case of febrile illness that was presented with mild symptoms. However, laboratory investigation confirmed a malaria and Rift Valley fever co-infection. Healthcare providers in settings endemic with several infectious diseases should seek rolling out possibilities of other infections prior to starting treatment for achieving effective case management with less resources and better safety of patients.

Abstract

Here we report a case of febrile illness that confirmed to be a co-infection of malaria and Rift Valley fever. The patient was initially diagnosed with malaria and started on treatment immediately. However, due to the lack of response to the treatment further laboratory investigations were pursued.

The First Case of Fusarium falciforme Eumycetoma in Sudan and an Extensive Literature Review about Treatment Worldwide

Eumycetoma is an infectious disease caused by various fungal pathogens. The disease is characterised by black and pale-yellowish grain discharge. In this communication, we report a case of eumycetoma with a pale grain foot-eumycetoma caused by Fusarium falciforme. The patient presented at the outpatient clinic of the Mycetoma Research Centre in Sudan. The causative agent was initially misidentified as Aspergillus nidulans based on its seemingly similar histopathological appearance. However, sequencing the internally transcribed spacer region of the extracted grain confirmed infection with Fusarium falciforme. Although the patient received Itraconazole and underwent surgical excision, the disease was recurrent. To our knowledge, this is the first report on Fusarium falciforme causing eumycetoma in Sudan, indicating the expansion of the geographical distribution of this pathogen. This calls for raising the awareness of healthcare providers and improving the diagnostic and surveillance systems in at-risk areas to improve the case management and reduce the threat of further spread. Considering the potential impacts of F. falciforme infection including threatening the global health, food security, and ecosystem balance, as well as loss of biodiversity and negative socioeconomic changes in endemic countries, we recommend the implementation of an integrated transdisciplinary One Health strategy for the prevention and control of emerging infectious diseases including F. falciforme.

Sudden emergence and spread of cutaneous larva migrans in Sudan: A case series calls for urgent actions

Cutaneous larva migrans (CLM) is a self-limiting dermatosis parasitic disease that is caused by zoonotic hookworm mainly infects cats, dogs, and accidentally humans. The disease affects hosts through the invasion and the migration of the hookworm larva into top layers of the skin. The disease occurs in tropical and subtropical regions; where people commonly are infected when sitting or barefoot walking on places contaminated with feces of infected cats or dogs. Due to self-limiting nature of the disease, the exact burden and prevalence are commonly underestimated. In this communication, we investigated all cases presented to the skin-diseases outpatient clinic' at the reference hospital of Tropical Diseases Medicine in Khartoum state between January 2019 and January 2021. This is the first-ever a case series report of cutaneous larva migrans in Sudan. We identified 15 cases of CLM presented with rash (100 %), redness of skin (67 %), and only adults were presented with larva crawling under their skins (27 %). Infection sites were (53 %) leg, (40 %) foot, only 7 % showed abdominal infection. The majority of patients were children or young adults, 47 % of them are ≤5 year-old, male to female ratio is 2.75:1. Duration of infection was one to three weeks and all patients fully recovered after treatment with albendazole. This urges for One Health interventions including deworming cats and dogs, improving water, sanitation, and hygiene, community-engagement and raising awareness in area with risk of infection.

The First Molecular Detection of Aedes albopictus in Sudan Associates with Increased Outbreaks of Chikungunya and Dengue

As part of our surveys of the invasive malaria vector Anopheles stephensi in four Sudanese states, including North and South Kordofan, Sennar, and White Nile, we collected 166 larvae. Our morphological identification confirmed that 30% of the collected mosquito samples were Anopheles species, namely An. gambiae s.l. and An. stephensi, while the 117 Aedes specimens were Ae. luteocephalus (39%), Ae. aegypti (32%), Ae. vexans (9%), Ae. vittatus (9%), Ae. africanus (6%), Ae. metalicus (3%), and Ae. albopictus (3%). Considering the serious threat of Ae. albopictus emergence for the public health in the area and our limited resources, we prioritized Ae. albopictus samples for further genomic analysis. We extracted the DNA from the three specimens and subsequently sequenced the cytochrome oxidase 1 (CO1) gene and confirmed their identity as Aedes albopictus and their potential origin by phylogenetic and haplotype analyses. Aedes albopictus, originating from Southeast Asia, is an invasive key vector of chikungunya and dengue. This is the first report and molecular characterization of Ae. albopictus from Sudan. Our sequences cluster with populations from the Central African Republic and La Réunion. Worryingly, this finding associates with a major increase in chikungunya and dengue outbreaks in rural areas of the study region and might be linked to the mosquito’s spread across the region. The emergence of Ae. albopictus in Sudan is of serious public health concern and urges for the improvement of the vector surveillance and control system through the implementation of an integrated molecular xenosurveillance. The threat of major arboviral diseases in the region underlines the need for the institutionalization of the One Health strategy for the prevention and control of future pandemics.