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Schwartz L, Nouvet E, de Laat S, Yantzi R, Wahoush O, Khater WA, Rwililiza EM, Abu-Siam I, Krishnaraj G, Amir T, Bezanson K, Wallace CS, Sow OB, Diallo AA, Diallo FB, Elit L, Bernard C, Hunt M. Aid when 'there is nothing left to offer': Experiences of palliative care and palliative care needs in humanitarian crises. PLOS Glob Public Health 2023; 3:e0001306. [PMID: 36962993 PMCID: PMC10021221 DOI: 10.1371/journal.pgph.0001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/11/2022] [Indexed: 04/18/2023]
Abstract
Access to palliative care, and more specifically the alleviation of avoidable physical and psychosocial suffering is increasingly recognized as a necessary component of humanitarian response. Palliative approaches to care can meet the needs of patients for whom curative treatment may not be the aim, not just at the very end of life but alleviation of suffering more broadly. In the past several years many organizations and sectoral initiatives have taken steps to develop guidance and policies to support integration of palliative care. However, it is still regarded by many as unfeasible or aspirational in crisis contexts; particularly where care for persons with life threatening conditions or injuries is logistically, legally, and ethically challenging. This article presents a synthesis of findings from five qualitative sub-studies within a research program on palliative care provision in humanitarian crises that sought to better understand the ethical and practical dimensions of humanitarian organizations integrating palliative care into emergency responses. Our multi-disciplinary, multi-national team held 98 in-depth semi-structured interviews with people with experiences in natural disasters, refugee camps in Rwanda and Jordan, and in Ebola Treatment Centers in Guinea. Participants included patients, family members, health care workers, and other staff of humanitarian agencies. We identified four themes from descriptions of the struggles and successes of applying palliative care in humanitarian settings: justification and integration of palliative care into humanitarian response, contextualizing palliative care approaches to crisis settings, the importance of being attentive to the 'situatedness of dying', and the need for retaining a holistic approach to care. We discuss these findings in relation to the ideals embraced in palliative care and corresponding humanitarian values, concluding that palliative care in humanitarian response is essential for responding to avoidable pain and suffering in humanitarian settings.
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Affiliation(s)
- Lisa Schwartz
- Health Research, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Elysée Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
| | - Sonya de Laat
- Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Yantzi
- Health Research, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Wejdan A. Khater
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Ar Ramtha, Jordan
| | | | | | | | - Takhliq Amir
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kevin Bezanson
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | - Oumou Bah Sow
- Ministère de la santé, Conakry, Guinée
- Université de Conakry, Conakry, Guinée
| | | | | | - Laurie Elit
- Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Carrie Bernard
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Nouvet E, Bezanson K, Hunt M, Kouyaté S, Schwartz L, Diallo FB, de Laat S, Bah-Sow OY, Diallo AA, Diallo P. Dying in honour: experiences of end-of-life palliative care during the 2013-2016 Ebola outbreak in Guinea. J Int Humanit Action 2021; 6:10. [PMID: 38624820 PMCID: PMC8105689 DOI: 10.1186/s41018-021-00099-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/15/2021] [Indexed: 04/17/2024]
Abstract
With no cure and a high mortality rate, Ebola virus disease (EVD) outbreaks require preparedness for the provision of end-of-life palliative care. This qualitative study is part of a larger project on palliative care in humanitarian contexts. Its goal was to document and deepen understanding of experiences and expectations related to end-of-life palliative care for patients infected with Ebola virus disease (EVD) in West African Ebola treatment centres (ETCs) during the 2013-2016 epidemic. It consisted of 15 in-depth semi-structured interviews with individuals impacted by EVD in a Guinean ETC: either as patients in an ETC, healthcare providers, healthcare providers who were also EVD patients at one point, family relations who visited patients who died in an ETC, or providers of spiritual support to patients and family. Analysis was team based and applied an interpretive descriptive approach. Healthcare delivery in humanitarian emergencies must remain respectful of patient preferences but also local and contextual values and norms. Of key importance in the Guinean context is the culturally valued experience of "dying in honour". This involves accompaniment to facilitate a peaceful death, the possibility of passing on final messages to family members, prayer, and particular practices to enact respect for the bodies of the deceased. Participants emphasized several challenges to such death in Ebola treatment centres (ETCs), as well as practices they deemed helpful to alleviating dying patients' suffering. An overarching message in participants' accounts was that ideally more would have been done for the dying in ETCs. Building on participants' accounts, we outline a number of considerations for optimizing end-of-life palliative care during current and future public health emergencies, including for COVID-19.
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Affiliation(s)
- Elysée Nouvet
- School of Health Studies, Western University, London, Canada
| | - Kevin Bezanson
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sekou Kouyaté
- Laboratoire Socio-Anthropologique de la Guinée, Conakry, Guinea
| | - Lisa Schwartz
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Fatoumata Binta Diallo
- Faculté des Sciences et Techniques en Santé, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - Sonya de Laat
- Global Health Program, McMaster University, Hamilton, Canada
| | | | - Alpha Ahmadou Diallo
- Ministry of Health, Republic of Guinea and Université de Conakry, Conakry, Guinea
| | - Pathé Diallo
- Centre Médical & Conseil en Santé (CEMECO), Conakry, Guinea
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Ambler J, Diallo AA, Dearden PK, Wilcox P, Hudson M, Tiffin N. Including Digital Sequence Data in the Nagoya Protocol Can Promote Data Sharing. Trends Biotechnol 2020; 39:116-125. [PMID: 32654776 DOI: 10.1016/j.tibtech.2020.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
The Nagoya Protocol (NP), a legal framework under the Convention on Biological Diversity (CBD), formalises fair and equitable sharing of benefits arising from biological diversity. It encompasses biological samples and associated indigenous knowledge, with equitable return of benefits to those providing samples. Recent proposals that the use of digital sequence information (DSI) derived from samples should also require benefit-sharing under the NP have raised concerns that this might hamper research progress. Here, we propose that formalised benefit-sharing for biological data use can increase willingness to participate in research and share data, by ensuring equitable collaboration between sample providers and researchers, and preventing exploitative practices. Three case studies demonstrate how equitable benefit-sharing agreements might build long-term collaborations, furthering research for global benefits.
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Affiliation(s)
- Jon Ambler
- Computational Biology Division, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
| | | | - Peter K Dearden
- Genomics Aotearoa and Biochemistry Department, University of Otago, Dunedin, New Zealand
| | - Phil Wilcox
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Maui Hudson
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
| | - Nicki Tiffin
- Computational Biology Division, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Guilavogui T, Camara A, Diallo EM, Koïvogui A, Barry A, Zoumanigui K, Diallo AA, Delamou A, Koulibaly M. Organisational framework and outputs of International medical evacuation in Guinea: A need for change. Int J Health Plann Manage 2018; 33:614-626. [PMID: 29446151 DOI: 10.1002/hpm.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
The study aims to describe the organizational framework of International Medical Evacuation (IME), the profile of persons evacuated, and the associated cost of IME in Guinea. This was a descriptive study of IME policy in Guinea. We described the politico-structural organization of IME and the profile of patient accessing IME through the Ministry of Health (MOH: 2001-2015) and through the National Social Security Fund (NSSF: 2011-2015). From 1958 to 1992 since the health system was restricted, the country negotiated the free medical treatment with Socialist countries. Since 1992, a medical assistance line was included in the sector budgets, and IME was officially managed by the MOH and with a parallel system existing at the NSSF. With an average cost of US $34 251 per case, cardiovascular diseases (20%), Traumatology/Orthopedic diseases (20%), and Neurologic/neurosurgery diseases (12.5%) have motivated more than half of 2445 IME supported by the MOH between 2001 and 2015. With a diagnostic exploration (38.7%) as main motivation, the majority of the IMEs (80.0%) endorsed by the NSSF (2011-2015) concerned their employees/workers or those of the NSSF's supervisory ministry and their families. Despite a strict regulatory framework, the emergence and sustainability of parallel IME systems in other departments with different procedures than MOH's procedure represent a major weakness/deficiency. The new prospects for the free medical treatment of state employees could eventually lead to an effective correction of this structural failure if efficiently managed.
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Affiliation(s)
- Timothé Guilavogui
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
- Programme National de Lutte contre le Paludisme, Conakry, Guinée
| | - Alioune Camara
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
- Programme National de Lutte contre le Paludisme, Conakry, Guinée
| | - Elhadj Marouf Diallo
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
| | - Akoï Koïvogui
- Comité Départemental des Cancers (CDC93), Bondy, France
| | | | | | - Alpha Ahmadou Diallo
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
| | - Alexandre Delamou
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire de Santé Publique, Université de Conakry, Conakry, Guinée
| | - Moussa Koulibaly
- CHU De Conakry, Hôpital National Ignace Deen, Direction Générale, Conakry, Guinea
- Faculté de Médecine-Pharmacie-Odonto-Stomatologie, Chaire d'Anatomo-Pathologie, Université de Conakry, Conakry, Guinée
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Jalloh MF, Bunnell R, Robinson S, Jalloh MB, Barry AM, Corker J, Sengeh P, VanSteelandt A, Li W, Dafae F, Diallo AA, Martel LD, Hersey S, Marston B, Morgan O, Redd JT. Assessments of Ebola knowledge, attitudes and practices in Forécariah, Guinea and Kambia, Sierra Leone, July-August 2015. Philos Trans R Soc Lond B Biol Sci 2017; 372:rstb.2016.0304. [PMID: 28396475 DOI: 10.1098/rstb.2016.0304] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/12/2022] Open
Abstract
The border region of Forécariah (Guinea) and Kambia (Sierra Leone) was of immense interest to the West Africa Ebola response. Cross-sectional household surveys with multi-stage cluster sampling procedure were used to collect random samples from Kambia (n = 635) in July 2015 and Forécariah (n = 502) in August 2015 to assess public knowledge, attitudes and practices related to Ebola. Knowledge of the disease was high in both places, and handwashing with soap and water was the most widespread prevention practice. Acceptance of safe alternatives to traditional burials was significantly lower in Forécariah compared with Kambia. In both locations, there was a minority who held discriminatory attitudes towards survivors. Radio was the predominant source of information in both locations, but those from Kambia were more likely to have received Ebola information from community sources (mosques/churches, community meetings or health workers) compared with those in Forécariah. These findings contextualize the utility of Ebola health messaging during the epidemic and suggest the importance of continued partnership with community leaders, including religious leaders, as a prominent part of future public health protection.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Mohamed F Jalloh
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Rebecca Bunnell
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Susan Robinson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | - Amanda VanSteelandt
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Wenshu Li
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Foday Dafae
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Lise D Martel
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Sara Hersey
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Barbara Marston
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Oliver Morgan
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - John T Redd
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Irwin KL, Jalloh MF, Corker J, Alpha Mahmoud B, Robinson SJ, Li W, James NE, Sellu M, Jalloh MB, Diallo AA, Tracy L, Hajjeh R, VanSteelandt A, Bunnell R, Martel L, Raghunathan PL, Marston B. Attitudes about vaccines to prevent Ebola virus disease in Guinea at the end of a large Ebola epidemic: Results of a national household survey. Vaccine 2017; 35:6915-6923. [PMID: 28716555 DOI: 10.1016/j.vaccine.2017.06.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/22/2017] [Accepted: 06/09/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In 2014-2016, an Ebola epidemic devastated Guinea; more than 3800 cases and 2500 deaths were reported to the World Health Organization. In August 2015, as the epidemic waned and clinical trials of an experimental, Ebola vaccine continued in Guinea and neighboring Sierra Leone, we conducted a national household survey about Ebola-related knowledge, attitudes, and practices (KAP) and opinions about "hypothetical" Ebola vaccines. METHODS Using cluster-randomized sampling, we selected participants aged 15+ years old in Guinea's 8 administrative regions, which had varied cumulative case counts. The questionnaire assessed socio-demographic characteristics, experiences during the epidemic, Ebola-related KAP, and Ebola vaccine attitudes. To assess the potential for Ebola vaccine introduction in Guinea, we examined the association between vaccine attitudes and participants' characteristics using categorical and multivariable analyses. RESULTS Of 6699 persons invited to participate, 94% responded to at least 1 Ebola vaccine question. Most agreed that vaccines were needed to fight the epidemic (85.8%) and that their family would accept safe, effective Ebola vaccines if they became available in Guinea (84.2%). These measures of interest and acceptability were significantly more common among participants who were male, wealthier, more educated, and lived with young children who had received routine vaccines. Interest and acceptability were also significantly higher among participants who understood Ebola transmission modes, had witnessed Ebola response teams, knew Ebola-affected persons, believed Ebola was not always fatal, and would access Ebola treatment centers. In multivariable analyses of the majority of participants living with young children, interest and acceptability were significantly higher among those living with vaccinated children than among those living with unvaccinated children. DISCUSSION The high acceptability of hypothetical vaccines indicates strong potential for introducing Ebola vaccines across Guinea. Strategies to build public confidence in use of Ebola vaccines should highlight any similarities with safe, effective vaccines routinely used in Guinea.
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Affiliation(s)
- Kathleen L Irwin
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Mohamed F Jalloh
- Focus 1000, 15 Main Motor Road, Brookfields, Freetown, Sierra Leone.
| | - Jamaica Corker
- Consultant to the Centers for Disease Control and Prevention, Atlanta, 1600 Clifton Road NE, Atlanta, GA 30329, USA.
| | | | - Susan J Robinson
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Wenshu Li
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Nyuma E James
- Focus 1000, 15 Main Motor Road, Brookfields, Freetown, Sierra Leone.
| | - Musa Sellu
- Focus 1000, 15 Main Motor Road, Brookfields, Freetown, Sierra Leone.
| | - Mohammad B Jalloh
- Focus 1000, 15 Main Motor Road, Brookfields, Freetown, Sierra Leone.
| | | | - LaRee Tracy
- Food and Drug Administration, Center for Drug Evaluation and Research, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Rana Hajjeh
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Amanda VanSteelandt
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Rebecca Bunnell
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Lise Martel
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Pratima L Raghunathan
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Barbara Marston
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
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Beavogui AH, Delamou A, Yansane ML, Konde MK, Diallo AA, Aboulhab J, Bah-Sow OY, Keita S. Clinical research during the Ebola virus disease outbreak in Guinea: Lessons learned and ways forward. Clin Trials 2016; 13:73-8. [PMID: 26768557 DOI: 10.1177/1740774515619877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea Department of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Dentistry, Gamal University of Conakry, Conakry, Guinea
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, Gamal University of Conakry, Conakry, Guinea Maternal and Child Health Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | | | - Mandy Kader Konde
- Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, Gamal University of Conakry, Conakry, Guinea National Ebola Control Coordination, Conakry, Guinea
| | - Alpha Ahmadou Diallo
- Maternal and Child Health Unit, Institute of Tropical Medicine Antwerp, Antwerp, Belgium Ministry of Health, Conakry, Guinea
| | | | | | - Sakoba Keita
- National Ebola Control Coordination, Conakry, Guinea Division Prévention et Lutte contre les maladies, Ministry of Health, Conakry, Guinea
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Padane A, Camara M, Seydi M, Jennes W, Diallo AA, Fall M, Diaw PA, Sow PS, Mboup S, Kestens L, Dieye TN. Resistance to HIV-1 infection among HIV-exposed seronegative partners in HIV-discordant couples is associated with higher frequency of CD8+ T cells expressing CD107a and b molecules. BMC Infect Dis 2014. [PMCID: PMC4220991 DOI: 10.1186/1471-2334-14-s2-p67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leach MA, Fairhead JR, Millimouno D, Diallo AA. New therapeutic landscapes in Africa: parental categories and practices in seeking infant health in the Republic of Guinea. Soc Sci Med 2008; 66:2157-67. [PMID: 18314240 DOI: 10.1016/j.socscimed.2008.01.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Indexed: 11/25/2022]
Abstract
In considering African health care practice, it is usual to draw strong distinctions between biomedical and traditional practices, and between public and private health institutions. Whilst distinctions between traditional and biomedical, and between public and private medicine make sense from the vantage point of health professionals, we question how far these distinctions are pertinent in shaping health-seeking behaviour given experience of them. This paper argues that other distinctions are becoming far more important to African therapeutic landscapes to the ways that people evaluate the salience of different health providers to their problems. We draw on ethnographic research and illustrative evidence from 1550 'infant health biographies' from rural and urban areas in the Republic of Guinea, where 93% of health expenditure takes place outside the state sector. We outline the distinctions that inform parents' health-seeking practices here. These include distinctions between women's and children's health providers (at state health centres), and those that men frequent (private pharmacies); between familiar ailments with known therapies (whether self-treatment, biomedical or herbal), and unfamiliar ones requiring expert diagnostics (whether from Islamic healers, diviners or doctors); between illnesses treatable by injection, and those aggravated by injection; between types of payment; and between high quality/strong medicines, and poor quality/weak ones. As people engage with emergent therapeutic landscapes, relations of knowledge and expertise, and forms of social solidarity, are emerging with significant implications for potential pathways of health system development, how these are conceptualised, and the forms of citizenship and partnership they might involve.
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Affiliation(s)
- Melissa A Leach
- Department of Anthropology, University of Sussex, East Sussex, United Kingdom.
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Criel B, Diallo AA, Van der Vennet J, Waelkens MP, Wiegandt A. [Difficulties in partnerships between health professionals and Mutual Health Organisations: the case of Maliando in Guinea-Conakry]. Trop Med Int Health 2005; 10:450-63. [PMID: 15860092 DOI: 10.1111/j.1365-3156.2005.01410.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 1998, a Mutual Health Organization (MHO) was created in the region of Guinee forestiere in Guinea-Conakry, West Africa, in the context of the action-research project PRIMA (Projet de recherche sur le partage du risque maladie). The aim of the project was to test whether, and under which conditions, an MHO can improve the access to quality health care. The specificity of the model is double-sided: on the one hand, the wish to integrate the organization into the local health system through a partnership between MHO and health services; on the other hand, the systematic efforts by the local research team to involve health professionals, at both the operational and managerial level of the system, in the planning and implementation of the MHO. We present the results of a study that investigates the health professionals' perception of this model. In April 2000, semi-structured interviews were held with 16 health professionals working at the different operational, managerial and administrative levels of the Guinean health system. The professionals perceive the MHO as an effective strategy to overcome financial accessibility problems. However, the interviews highlight the uncertainties and worries of the health professionals, their lack of understanding of the model, their reluctance even to fully accept it. The partnership approach was not internalized. They understand the technical instrument, but are confused and uncomfortable in their dialogue with the population. This study illustrates the difficulties of establishing a real partnership between population and health services, as well as the need for proper training and coaching of the health workers in the set-up of MHOs. The importance of this aspect was insufficiently recognized by the research team, despite its good intentions and its huge investment in organizing exchange between stakeholders. An important lesson of this experience is the need for promoters to conceive and operate MHO systems in which the expectations and fears of the health care providers are better identified and better taken into account.
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Affiliation(s)
- Bart Criel
- Département de Santé publique de l'Institut de médecine tropicale, Anvers, Belgique.
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Gray JT, WaKabongo M, Campos FE, Diallo AA, Tyndal C, Tucker CA. Recognition of Yersinia enterocolitica multiple strain infection in twin infants using PCR-based DNA fingerprinting. J Appl Microbiol 2001; 90:358-64. [PMID: 11298230 DOI: 10.1046/j.1365-2672.2001.01252.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Yersinia enterocolitica causes several syndromes in humans. The most common presentation is enterocolitis in children, presenting as fever and diarrhoea. A Y. enterocolitica multiple strain infection in twin infants was investigated. METHODS AND RESULTS One isolate was recovered from one patient and two morphologically-different isolates were recovered from the other infant. Biochemically, all isolates were identified as Y. enterocolitica group. The genomic DNA from each strain was purified and DNA fingerprinting was performed. The banding patterns observed for Y. enterocolitica isolates 2 and 3, from patients 1 and 2, respectively, were identical when comparing the presence or absence of major bands. However, Y. enterocolitica isolate 1, from patient 1, showed a distinctive banding pattern from isolates 2 and 3. CONCLUSION The findings indicate that one infant was colonized by more than one strain of Y. enterocolitica, demonstrating that multiple strains can colonize and invade a patient. SIGNIFICANCE AND IMPACT OF THE STUDY Recognition of multiple strain infections can be important in diagnosis, treatment and prognosis of Y. enterocolitica infections, as well as in disease epidemiology. The technique described here offers a straightforward method for strain comparison.
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Affiliation(s)
- J T Gray
- USDA, ARS, Antimicrobial Resistance Research Unit, Athens, GA 30605, USA.
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Sow O, Frechet M, Diallo AA, Soumah S, Conde MK, Diot P, Boissinot E, Lemarié E. Community acquired pneumonia in adults: a study comparing clinical features and outcome in Africa (Republic of Guinea) and Europe (France). Thorax 1996; 51:385-8. [PMID: 8733490 PMCID: PMC1090673 DOI: 10.1136/thx.51.4.385] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Community acquired pneumonia is the most common cause of death from infectious disease both in western and developing countries. A study was carried out in Conakry, Republic of Guinea and Tours, France in order to compare signs, symptoms, severity of illness, risk factors, and clinical outcome of community acquired pneumonia in adult patients admitted to hospital. METHODS The study was performed in the cities of Conakry and Tours over the same one year period. Patients with nosocomial pneumonia, tuberculosis, and those who were HIV positive were excluded. Data were recorded on the same forms in both centres. A severity score was calculated according to American Thoracic Society criteria. Follow up was evaluated at days 2, 7 and 15. RESULTS A total of 333 patients (218 from Conakry, 115 from Tours) were included in the study with a diagnosis of community acquired pneumonia, with or without lung abscess or pleural effusion. Mean age was higher and pre-existing illness rate, dehydration, agitation, and stupor were more frequent in patients in Tours. Respiration rates of > 30 breaths/min and the incidence of crackles were identical in the two centres. Fever above 39 degrees C, initial shock, chest pain, and herpes were significantly more frequent in Conakry. Initial chest radiographic abnormalities were similar in the two groups, ranging from unilateral pleuropulmonary involvement (89% and 83% in Conakry and Tours, respectively) to diffuse patchy parenchymal disease. Parapneumonic effusion was present in 17% and 16% of the patients of Conakry and Tours, respectively. Pneumonia was considered to be severe in 33% and 42% of the patients, respectively. In Conakry first line antibiotic therapy was penicillin alone (2 million units a day) for 197 patients (90%) and second line antibiotic therapy was prescribed for 25 patients (12%). In Tours first line therapy consisted of a single antibiotic (amoxicillin, third generation cephalosporins) for 65 patients (57%) and second line antibiotic therapy was prescribed for 55 patients (48%). The clinical outcome was similar in Conakry and Tours: 88% and 85% of patients, respectively, were afebrile or clinically cured at day 15. The mortality rate was similar (6% and 8%, respectively). CONCLUSIONS The problems encountered in the management of community acquired pneumonia are quite different in western and developing countries. This study shows that low doses of penicillin can cure 90% of African patients with pneumonia as effectively as more aggregative treatments in European patients who are both older and have greater comorbidity. Although pneumococci with reduced penicillin sensitivity occur in western countries, this does not seem to be the case in black Africa. For these reasons, low doses of penicillin or amoxicillin remain good first line treatment.
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Affiliation(s)
- O Sow
- Service de Pneumologie, Universitaire de Conakry, République de Guinée
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Pons JC, Diallo AA, Eydoux P, Rais S, Doumerc S, Frydman R, Papiernik E. Chorionic villus sampling after first trimester diagnosis of fetal cystic hygroma colli. Eur J Obstet Gynecol Reprod Biol 1989; 33:141-6. [PMID: 2684696 DOI: 10.1016/0028-2243(89)90206-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diagnostic findings of four cases of cystic hygroma discovered at 11 weeks of gestation are reported. The discovery of cystic hygroma by echotomography was followed by sample taking of chorionic villi which revealed one case of monosomy X and three cases of trisomy 18. Caryotype determination in the presence of cystic hydroma is essential for diagnostic confirmation and subsequent genetic counselling.
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Affiliation(s)
- J C Pons
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, Clamart, France
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Addo PB, Diallo AA. Investigation of the presence of Salmonella in two Nigerian meat packing plants. Afr J Med Med Sci 1982; 10:85-9. [PMID: 6289650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Two large and very well established meat processing plants supervised by the Veterinary Public Health Department were examined to assess the incidence of Salmonella within the premises and on the processed carcasses. The overall incidence was 65 out of the 252 samples or 25.9%. Salmonella was found in forty-one of 167 samples (25%) in one and twenty-four out of eighty-five samples (29%) in the other. The high incidence shows a high degree of probability of contamination of the products from both plants. The public health significance of the findings is emphasized and control problems are high-lighted.
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Diallo AA, Dennis SM. Bacteriological survey of leptospirosis in Zaria, Nigeria. Trop Geogr Med 1982; 34:29-34. [PMID: 7043824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A total of 252 rodents were trapped in the environs of Ahmadu Bello University, Zaria, over a two-year period, of which 221 were brown field rats (Arvicanthus niloticus). Only these were found positive (4.5%). Titers were detected against Leptospira interrogans, serovars australis, icterohaemorrhagiae, tarassovi and hardjo. All positive sera except one reacted against a single serovar. Eight isolates were obtained from field rats: five were serovar australis, one ballum and two unidentified. Five isolates were recovered from 74 bovine kidneys examined: one was serovar pyrogenes and four unidentified. One unidentified isolate failed to react with any of the 16 screening leptospira antisera and another was tentatively considered to be serovar ballum. Two isolates, one ballum and one unidentified, were recovered from the Kubani stream waters. No leptospira was isolated from piggery sewage effluents collected at Kano and Kaduna. It is suggested that serovar ballum be included in any screening battery for leptospirosis in man and animals in Nigeria.
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Abstract
Hydrogen sulfide production was noted in two Escherichia coli strands and one Provaidenica alcalifaciens (Proteus inconstans A) strain isolated from clinical stool specimens durin the summer of 1979. An investigation into this phenomenon revealed the predence of Eubacterium lentum, an anaerobe, growing in synergism with the Enterobacteriaceae and producing H2s. The implications of this association are discssed with reference to clinical microbiology laboratory practice.
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Diallo AA, Siverman M, Egler LJ. Bacteriology of lung puncture aspirates in malnourished children in Zaria. Niger Med J 1979; 9:421-3. [PMID: 539109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Diallo AA. Activity level of neurone in the lateral posterior thalamus of the cat during EEG: aspects of sleep and arousal [proceedings]. West Afr J Pharmacol Drug Res 1977; 4:48P-50P. [PMID: 602182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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